Vaccination of pregnant women in the Valencian Community during the 2014-15 influenza season: a multicentre study.

OBJECTIVE: To study influenza vaccination uptake in pregnant women from three Health Departments in the Valencian Community (Spain) during the 2014-15 flu season, to identify degree of knowledge, sources of information and attitudes toward immunization against influenza. METHODS: Multicentre cross-sectional descriptive study during the 2014-15 vaccination campaign. Vaccine coverage was determined using the Nominal Vaccination Registry (NVR). Subsequently, a telephone survey was carried out on a sample of vaccinated and unvaccinated postpartum women. RESULTS: The NVR had information on 934 (59.5%) out of 1,569 postpartum women; distribution per Health Departments was: 420 (44.9%), 161 (17.2%) and 353 (37.8%) in La Ribera, Torrevieja and Elx-Crevillent respectively. Vaccine uptake was 27.9% (n = 261). According to the "Country of Origin" variable, 77.5% (n = 724) of women were Spanish, with a vaccination rate of 26.7% (n = 193), compared to 22.5% (n = 210) who were non-Spanish, with a rate of 32.4% (n = 68). The main source of information was midwives for 83.7% (n = 159) of vaccinated pregnant women and for 44.6% (n = 127) of non-vaccinated women. The main reasons for vaccine refusal were lack of awareness (29.5%, n = 84) and not considering it necessary (25.6%, n = 73). CONCLUSIONS: Despite their high willingness to be vaccinated after receiving information about the flu vaccine, the vaccination coverage in pregnant women studied is still low and can be improved. Health professionals need new information strategies to extend vaccine uptake to a larger number of pregnant women in Spain. Midwife advice plays an essential role in transmitting information on influenza vaccination in pregnant women and has a significant impact on uptake.

The effectiveness of a hyperoxygenated fatty acid compound in preventing pressure ulcers.

OBJECTIVE: To compare the effects of Mepentol, a hyperoxygenated fatty acid preparation, with a placebo treatment in preventing the development of pressure ulcers. METHOD: The research study consisted of a multicentre double-blind randomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. In addition, Kaplan-Meier survival curves, with log-rank test, and Cox's proportional hazards regression model were used to compare both groups. RESULTS: A total of 331 patients completed the study: 167 in the control group and 164 in the study group. Pressure-ulcer incidence during the study was 7.32% in the intervention group versus 17.37% in the placebo group (p 0.006). These results show that for each 10 patients treated with Mepentol one pressure ulcer was prevented (NNT = 9.95). Survival curves and the regression model showed a significant statistical difference for both groups (p < or = 0.001). The average cost of Mepentol during the study was 7.74 Euro. CONCLUSION: Mepentol is an effective measure for pressure ulcer prevention. It was more effective than a greasy placebo product, and was found to be cost-effective.

[Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic]. / Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo.

INTRODUCTION: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as "trencar lenfit" (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. OBJECTIVES: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. PATIENTS AND METHOD: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. RESULTS: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 +/- 15.9 versus. 55.5 +/- 17.7 years +/- SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). CONCLUSION: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. "Experts" in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs.

[Antiretroviral pharmaceutical expenditure and possibilities for optimization]. / Gasto farmacéutico en medicación antirretroviral y posibilidades de optimización.

INTRODUCTION: A lack of treatment compliance, resistances and non-advanced stages of the disease are the reasons why not all HIV-infected patients benefit from the demonstrated efficacy of antiretroviral drug combinations--with the consequent important increase in costs. A prospective cohort follow-up study is conducted to analyze the distribution of antiretroviral pharmaceutical expenditure in a district hospital, and the possibilities for improving its efficiency. MATERIAL AND METHODS: The study comprised 128 HIV-infected patients seen for 12 consecutive weeks (September to November, 2004). The characteristics of previous follow-up were analyzed, and the patients were divided into groups according to the course over the following weeks and the results of prescribed treatment: group 1 (effective treatment), group 2 (ineffective treatment), and group 3 (treatment dropout). Based on the prescription history, corroborated with drug retrieval and the acquisition costs (FARMASYS software), the cost of antiretroviral medication was calculated for each of the 108 patients receiving highly active antiretroviral therapy (HAART). The statistical analysis was carried out with the SPSS version 11.5 statistical package, and considering statistical significance for p < 0.05. RESULTS: The cost generated by the 108 patients included during the study period who received HAART was 232,366 euros, with an average of 2,151 euros per patient and 19,363 euros per day of consultation. The distribution of patients and of the costs generated by the above defined groups was as follows: group 1: 79 patients (80.6%); group 2: 11 patients (10.6%); group 3: 18 patients (8.8%). In the group 1 patients, 15.2% of the antiretroviral expenditure corresponded to patients who had started therapy with a CD4+ count of > 350 cells/ml, while 45% had > 350 cells/ml at the present time, and 25.9% had > 500 cells/ml. Previous medication dropout was identified as a predictor of new dropouts and treatment failures. COMMENT: While the cost generated by antiretroviral medication is high, 19.4% is administered to patients who do not benefit from such treatment due to a lack of efficacy or dropouts, and in another 40-60% of cases the need for such treatment could be subject to consideration in view of the good immune status of the patients.

[The income level and life styles: towards a law of inverse prevention?]. / Nivel de renta y estilos de vida: hacia una ley de prevención inversa?

The study of the determinants of disease-related lifestyles may be relevant for better understanding the potential of health policies. In the present work, results of the analysis of the Elche Healthy Cities Interview Survey prevalence of some disease related lifestyles (physical activity level, cigarette consumption, and alcohol intake) are presented according to economic level as measured by monthly family income, 573 people randomly selected from the town rolls were interviewed at home. No associations were found between economic level and alcohol intake or present smoking status. But, trying to stop smoking and regular exercise were more frequent behaviors in higher economic groups. The ratio of prevalence of regular exercise was 1.73 in favor of the highest economic levels. The gradient found was statistically significant (chi 2 for trend = 17.4, p less than 0.01). The results may be of relevance when implementing health policies to overcome inequalities in health: "unequal interventions" may be more adequate.

[Consumption of medicinal herbs in patients attending a gastroenterology outpatient clinic]. / Consumo de hierbas medicinales en los pacientes de consultas externas de digestivo.

The consumption of medicinal herbs is one of the most important topics in alternative and complementary medicine. The widespread use of these substances among the general population gives rise to the possibility of therapeutic or toxic effects in patients seeking conventional medical assistance. To determine the frequency of medicinal herb use, the species consumed and the profile of medicinal herb consumers among patients with gastrointestinal disorders, patients attending the gastroenterology outpatient clinic of the Francesc de Borja district hospital (Gandía, Spain) over a 5-month period were interviewed and 539 valid questionnaires were obtained. A total of 34.7% of the interviewees had taken medicinal herbs at some time and 26.9% had used them in the last year. Self-prescription was reported by 67.1%. Medicinal herbs were mainly obtained in the pharmacy or herbalist's (74.7%). The results of medicinal herb therapy were considered good or excellent by 80.3% of the interviewees, average by 18.6% and poor by 1.1%. In the univariate analysis, medicinal herb consumption was positively associated with female sex (p < 0.001), a university education (p < 0.05), consumption of psychotropic drugs (p < 0.005), use of trencar l'enfit (TE, a common practice of magic medicine in Valencia) (p < 0.001), functional gastrointestinal disorders (p < 0.005) and a diagnosis of lower gastrointestinal disorder (p < 0.01). In the multivariate analysis, the variables that remained statistically significant were female sex (p < 0.005), university education (p < 0.01), use of TE and a diagnosis of lower gastrointestinal disorder. Fifty-seven botanical varieties were used. The most frequent varieties were Santolina chamaecyparissus (18.8%), Tilia platyphyllos (6.5%), Thymus vulgaris (6%), Equisetum ramosissimum (4.7%), Mentha pulegium (4.4%) and Valeriana officinalis (4.4%). The results show that consumption of medicinal herbs is frequent among patients attending the gastroenterology outpatient clinic of a district hospital. The probable profile of those showing maximum consumption is: female sex, university education, lower gastrointestinal disorder, functional gastrointestinal disorder, psychotropic drug consumption and use of TE.

Catheter-related bloodstream infection: burden of disease in a tertiary hospital.

BACKGROUND: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. AIM: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. METHODS: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. FINDINGS: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. CONCLUSION: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

[Factors associated with the prevalence of psychiatric morbidity in a health area]. / Factores asociados con la prevalencia de morbilidad psiquiátrica en una zona de salud.

OBJECTIVE: To determine the incidence of psychiatric morbidity (PM) in the area, and the associated demographic and socio-economic factors. DESIGN: Observational non-longitudinal study. SETTING: The population of a Basic Health Area. PARTICIPANTS: Simple random sample of persons over 15 years old, selected from municipal census lists, accurate at 00.4. Initial sample: 697 cases. Excluded: deceased (11) changed address (112) serious mental incapacity (7) and refusal to take part (64). Final sample: 503 cases. MEASUREMENTS AND MAIN RESULTS: Answering of the General Health Questionnaire of 28 items (GHQ-28) and a questionnaire with study variables, between October 1990 and November 1991. 99 cases answered by post, and 404 via home visit. A GHQ-28 score greater or equal to 7 was considered positive. The incidence of GHQ-28 positive values in the population was found to be 0.35 (IC-0.31-0.39) and that of PM was found to be 0.38 (IC: 0.31-0.44). A link was observed with educational level (OR = 2.0277; p = 0.0174) and with sex (OR = 1.76 40; p = 0.172). There were no differences between those who answered by post or at home (p = 0.21) nor between those answering at different times of the year (p = 0.78). CONCLUSIONS: There was a high incidence of PM in persons older than 15 in our health area. This incidence is associated in a significant way with level of education (higher amongst lower levels) and with sex (higher amongst women). These factors can be considered as risk markers which can help us to detect sufferers from this type of illness.

Estudio "Auriga-04" sobre la utilización de la gama de apósitos hidrocelulares Allevyn® en el tratamiento de heridas agudas por parte de profesionales de Atención Primaria / The use of Allevyn(R) hydrocellular dressings range in acute wounds– AURIGA-04 study in primary care

Aunque los apósitos de cura en ambiente (CAH) húmedo se han utilizado predominantemente en heridas crónicas, ello no es óbice para que su uso en heridas agudas permita solucionar algunos problemas, como el conseguir un ambiente óptimo que facilite la migración epitelial, así como una adecuada protección de las heridas y una correcta gestión del exudado. Es por ello que, dentro del marco del estudio AURIGA-04, nos planteamos la realización de un estudio prospectivo observacional, abierto y multicéntrico, de medidas repetidas en una cohorte de pacientes que presentan heridas agudas de diversa etiología en el que se incluyeron pacientes con heridas traumáticas, quirúrgicas o quemaduras tratados por profesionales de Atención Primaria, con el objetivo de generar evidencias acerca de la utilización de apósitos de CAH, en concreto, de la gama de apósitos hidrocelulares Allevyn®, en el tratamiento de heridas agudas. Se consideraron como criterios de exclusión heridas con signos clínicos de infección. Solo se incluyó una lesión por paciente. En el caso de los pacientes con heridas agudas, la muestra a estudio quedó compuesta por 61 pacientes con una edad media de 71,1 años; 36 casos corresponden a mujeres (60%). El estado general de salud de la muestra era bueno en un 49,1% de los casos y prácticamente la totalidad de los pacientes presentaba pluripatología. Un 10% de los pacientes consumía fármacos que podían interferir en la cicatrización y un 6% presentaba malnutrición. El 67,2% de las lesiones eran heridas traumáticas, el 24,6% quirúrgicas y un 8,2% quemaduras. Un 37% de las lesiones fueron clasificadas como superficiales y el 63% restante como profundas. Presentaban 64 días de evolución previa a su inclusión en el estudio y una superficie media de 23,34 cm2. Los pacientes permanecieron en el estudio un promedio de 43,6 días, con una cadencia de cambios de apósito cada 2,7 días. Durante el estudio cicatrizaron el 63,9% de las heridas, en un promedio de 40,9 días. La superficie inicial de las lesiones mostró una reducción significativa a lo largo del seguimiento (inicial: 23,34 cm2, final: 4,27 cm2, p< 0,001). En los modelos de regresión de Cox, sólo resultó estadísticamente significativa la edad del paciente, en el grupo de lesiones traumáticas (RR: -0,03, p= 0,039). Durante el período de seguimiento, un 80,3% de los pacientes fue tratado en combinación con Intrasite Conformable®, Iruxol Mono® o la combinación de ambos productos. Los profesionales que realizaron las curas con Allevyn® valoraron muy favorablemente su manejo durante todo el estudio; así, en más del 96% de los cambios se consideró fácil de colocar, en el 100% indoloro y también en el 100% de fácil retirada. A la vista de los resultados, los apósitos de CAH y, en concreto, la gama de apósitos Allevyn®, tienen una clara aplicación en el caso de las heridas agudas, permitiendo un óptimo abordaje local de las lesiones, proporcionando unos niveles óptimos de humedad, pH y temperatura para las células implicadas en el proceso de cicatrización. Así, se promueve la formación de tejido de granulación y facilita la epitelización, además de proteger la herida ante traumatismos y gérmenes

Although moist environment dressings have mainly been used for chronic wounds, they can also be used on acute wounds in order to achieve an optimum atmosphere that facilitates epithelial migration, providing adequate protection for the wounds as well as good exudate management. Hence, as part of the AURIGA-04 study, an observational study was carried out at different centres, involving repeated measures on a group of patients who presented diverse acute wounds, including patients with traumatic wounds, surgical wounds or burns treated by primary care professionals. The aim of this study was to find evidence about the use of moist environment dressings, specifically the Allevyn® range of hydrocellular dressings, in the treatment of acute wounds. The exclusion criterion considered was if the wounds had clinical signs of infection. Only one wound was included per patient. In the case of patients with acute wounds, the study sample was made up of 61 patients with an average age of 71.1; 36 cases were women (60%). The patient’s general state of health was good in 49.1% of cases and practically all the patients presented multiple pathologies. 10% of the patients were taking medication that could interfere with the healing process and 6% of the patients presented signs of malnutrition. 67.2% of the wounds were traumatic in origin, 24.6% were surgical and 8.2% were burns. 37% of the wounds were classified as superficial and the remaining 63% were deep. The wounds had been present for 64 days before the patient’s inclusion in the study and the average surface area was 23.34 cm2. The patients remained in the study programme for an average of 43.6 days and their dressings were changed every 2.7 days. During the study, 63.9% of the wounds healed in an average of 40.9 days. The initial surface area of the wounds was reduced significantly over the monitoring period (initial: 23.34 cm2, final: 4.27 cm2, p ≤ 0.001). When Cox regression models were applied, the age of the patient was only statistically significant in the group with traumatic wounds (RR: –0.03, p= 0.039). During the monitoring period, 80.3% of the patients were also treated with Intrasite Conformable®, Iruxol Mono® or a combination of both products. The professionals that treated the wounds with Allevyn® rated the product very highly throughout the study; in over 96% of dressing changes, they were assessed as very easy to apply, 100% painless and also 100% easy to remove. Given these results, moist environment dressings, particularly the Allevyn® range of dressings, have a clear application in the case of acute wounds, permitting optimum local treatment of the wounds, providing optimum levels of moisture, pH and temperature for the cells involved in the healing process. Thus the formation of granulation tissue is promoted and epithelisation is facilitated. Furthermore, the wound is also protected from traumas and germs

Estudio ATHAC 04-05: estudio observacional sobre el uso de apósitos neutros o impregnados en agente antibacteriano de una innovadora tecnologia patentada: la tecnología lípido coloidal (TLC) para el tratamiento de heridas agudas y/o crónicas / The ATHAC Survey 04-05: observational study regarding the use of neuter dressings or dressings impregnated in an antibacterian agent using an innovative patented technology: the lipid colloid technology for the treatment of acute and/or chronic wounds

Introducción: El estudio ATHAC recoge datos sobre heridas agudas y crónicas que son candidatas a un tratamiento a base de apósitos grasos neutros como la gama URGOTUL.Objetivos: Describir las características de las heridas, describir los tratamiento aplicados a estas heridas y explorar las opiniones de los profesionales de enfermería y los pacientes sobre los tratamientos en términos de aplicabilidad, adaptabilidad y confort para el paciente.Material y métodos: 1.500 pacientes fueron incluidos en el estudio de acuerdo al tipo de herida y a los tratamientos en uso. Se recogieron datos a partir de dos cuestionarios: uno para el paciente y otro para la enfermera responsable de sus cuidados. Las enfermeras recogieron los datos en el primer día de inclusión y los pacientes respondían al cuestionario 1 mes más tarde o antes si la herida había cicatrizado. Las variables recogidas por la enfermera fueron: datos sociodemográficos, etiología de las lesiones, características y localización de las heridas, aspectos y opiniones sobre el tratamiento. A los pacientes se les preguntó por la duración del tratamiento, el estado de la lesión en el momento de contestar y desde su punto de vista, así como su opinión sobre el dolor, satisfacción general y aceptabilidad. Se llevaron a cabo análisis descriptivos uni y bivariados. Para cada paciente, si tenía más de una lesión, se recogieron datos de la lesión de mayor tamaño.Resultados: Finalmente, se estudiaron 1.432 pacientes con una o más lesiones (420 tenían más de una lesión). El 60,4% eran mujeres y la edad media fue de 66 ± 19 años. En el caso de las heridas crónicas (657 lesiones) predominaron las úlceras venosas (47%) y las úlceras por presión (23%). En las heridas agudas (775 lesiones), la mayoría fueron traumáticas (41%) y quemaduras (32,5%). La principal localización en todas las lesiones fueron los miembros inferiores (57,4% en heridas crónicas y 39% en agudas). El 84,4% de los casos indicó presentar algún tipo de dolor previo al comienzo de este estudio. Al finalizar el estudio, un porcentaje menor del 20% indicó presentar algún tipo de dolor. El 72% de las heridas agudas y el 35% de las crónicas, como refieren los pacientes, había cicatrizado al finalizar el estudio (en un tiempo medio de entre 20- 40 días). El 54% de las heridas crónicas evoluciona favorablemente y el 26% de las agudas. Más del 80% de las heridas estudiadas fueron tratadas con la gama URGOTUL.Conclusión: URGOTUL es una buena opción para el tratamiento de este tipo de heridas, especialmente para las heridas agudas, en relación a su carácter atraumático y a su capacidad de cicatrización, así como la buena aceptación y satisfacción de los pacientes

Introduction: The ATHAC survey collected data on acute or chronic wounds that were candidates for a treatment with grassy dressings like URGOTUL.Aims: To describe the wound’s characteristics, to describe treatments applied to these woundsand to Explore Nurses’ and patients’ opinion about the treatments in terms of applicability, adaptability and patient comfort.Methods: 1,500 patients were included in the study according to wound types and treatments. Data were collected with nurses and patient questionnaires. Nurses collected data the first day of inclusion and patients respond one month after or when wounds healed. Variables collected by nurses were: demographic, aetiology, characteristics and location of the wound, aspects and opinions of the treatment. Patients were asked about duration of treatments, wound state from their point of view and opinions about pain, satisfaction and acceptability. Univariate and bivariate descriptive analysis were conducted. For each patient was selected the biggest wound for data collection.Results: Finally, 1432 patients with one or more lesions were studied (420 had more than one). 60,4% were women and the mean age was 66. Chronic wounds, mainly, were venous leg ulcer (47%) and pressure ulcers (23%). In acute wounds, were traumatic (41%) and burns (32,5%). The main location was inferior extremities (57,4% in chronic and 39% in acute). 49% of cases reported moderate to high spontaneous pain previous to this study. At the end, only 20-30% reported pain (during the study, in more than 80% the dressing used was Urgotul). 72% of acute wounds and 35% of chronic wounds, as referred by patients, were healed when finished the study (between 20-40 days of treatment).Conclusion: Urgotul is a good option for atraumatic treatment of this type of lesions, mainly for acute wounds, since more of them had healed in an acceptable time with a good patient satisfaction

Gasto farmacéutico en medicación antirretroviral y posibilidades de optimización / Antiretroviral pharmaceutical expenditure and posibilities for optimization

Introducción: La falta de adherencia, las resistencias y las fases no avanzadas de la enfermedad, hacen que no todos los pacientes con infección por el VIH se beneficien de la demostrada eficacia de las combinaciones de fármacos antirretrovirales, lo que supone una proporción importante del elevado gasto que generan. Nos planteamos analizar, mediante estudio prospectivo de seguimiento de cohortes, como se distribuye el gasto farmacéutico en medicación antirretroviral en un hospital comarcal y las posibilidades de mejorar su eficiencia. Material y métodos: Se incluyeron 128 pacientes con infección por VIH atendidos durante 12 semanas consecutivas (septiembre a noviembre del 2004). Se analizaron las características de los seguimientos previos, y, según la evolución en las semanas siguientes y el resultado del tratamiento pautado, se clasificaron los pacientes en grupos: grupo 1 tratamiento efectivo, grupo 2 tratamiento no efectivo y grupo 3 abandonos de tratamiento. Con la historia de prescripción, corroborada con la recogida de medicación y los costos de adquisición (programa informático FARMASYS®), se calculó el gasto en medicación antirretroviral generado en cada uno de los 108 pacientes que recibieron TARGA. El análisis estadístico se realizó mediante SPSS 11,5 utilizando como criterio de significación estadística una p < 0,05. Resultados: El gasto total generado en los 108 pacientes incluidos durante el periodo de estudio que recibieron TARGA fue de 232.366 €, lo que supone una media de 2.151 € por paciente y 19.363 € por día de consulta. La distribución de los pacientes y del gasto generado por los grupos antes definidos es la siguiente: grupo 1: 79 pacientes (80,6%); grupo 2: 11 pacientes (10,6%); grupo 3: 18 pacientes (8,8%). Entre los pacientes del grupo 1, un 15,2 % del gasto en terapia antirretroviral se distribuyó a pacientes que la habían iniciado con un recuento de CD4 de más de 350 células/ml, un 45% a pacientes que se encontraban en el momento actual con más de 350 células/ml y un 25,9% a pacientes con recuentos de más de 500 células/ml. El antecedente de abandonos previos de la medicación se comportó como predictor de nuevos abandonos y fracasos terapéuticos. Comentario: El gasto generado por la medicación antirretoviral es elevado aunque en un 19,4% se administra a pacientes que no se benefician de él por falta de eficacia o abandonos, y en otro 40 a 60% podría plantearse su necesidad dada la buena situación inmunológica de los enfermos

Introduction: A lack of treatment compliance, resistances and non-advanced stages of the disease are the reasons why not all HIV-infected patients benefit from the demonstrated efficacy of antiretroviral drug combinations – with the consequent important increase in costs. A prospective cohort follow-up study is conducted to analyze the distribution of antiretroviral pharmaceutical expenditure in a district hospital, and the possibilities for improving its efficiency. Material and methods: The study comprised 128 HIV-infected patients seen for 12 consecutive weeks (September to November, 2004). The characteristics of previous follow-up were analyzed, and the patients were divided into groups according to the course over the following weeks and the results of prescribed treatment: group 1 (effective treatment), group 2 (ineffective treatment), and group 3 (treatment dropout). Based on the prescription history, corroborated with drug retrieval and the acquisition costs (FARMASYS® software), the cost of antiretroviral medication was calculated for each of the 108 patients receiving highly active antiretroviral therapy (HAART). The statistical analysis was carried out with the SPSS version 11.5 statistical package, and considering statistical significance for p 350 cells/ml, while 45% had > 350 cells/ml at the present time, and 25.9% had > 500 cells/ml. Previous medication dropout was identified as a predictor of new dropouts and treatment failures. Comment: While the cost generated by antiretroviral medication is high, 19.4% is administered to patients who do not benefit from such treatment due to a lack of efficacy or dropouts, and in another 40-60% of cases the need for such treatment could be subject to consideration in view of the good immune status of the patients

Efectividad de un compuesto de ácidos grasos hiperoxigenados en la prevención de las úlceras por presión / Efficiency of a hyperoxigenated fatty acid compound in the prevention of pressure

Objetivo: Comparar los efectos de Mepentol®, un compuesto de ácidosgrasos hiperoxigenados, frente a placebo en la prevención del desarrollode úlceras por presión. Material y métodos: El estudio de investigaciónconsistió en un ensayo clínico aleatorizado, multicéntrico y dobleciego. Se calculó: la incidencia de úlceras por presión, riesgo relativo(RR), fracción prevenible (FP) y número necesario a tratar (NNT).Además, se aplicaron curvas de supervivencia de Kaplan-Meier conpruebas de log-rank y modelos de riesgos proporcionales de regresión deCox para comparar ambos grupos. Resultados: Completaron el estudioun total de 331 pacientes: 167 en el grupo control y 164 en el grupo aestudio. La incidencia de las úlceras por presión durante el estudio fuede 7,32% en el grupo de intervención frente a 17,37% en el grupo placebo(p= 0,006). Estos resultados muestran que por cada 10 pacientestratados con Mepentol® se previene la aparición de una úlcera por presión(NNT= 9,95). Las curvas de supervivencia y los modelos de regresiónmuestran una diferencia estadísticamente significativa para ambosgrupos (p≤ 0,001). El coste medio del uso de Mepentol® durante elestudio fue de 7,74 €. Conclusión: Mepentol® es una medida efectivapara la prevención de úlceras por presión. Fue más efectiva que un placebograso y demostró ser coste-efectiva. Declaración de interés: elestudio fue esponsorizado por Laboratorios Bama-Geve SA, Barcelona, España

Objective: To compare the effects of Mepentol®, a hyperoxygenated fatty acidpreparation, with a placebo treatment in preventing the development of pressureulcers. Method: The research study consisted of a multicentre double-blindrandomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. Inaddition, Kaplan-Meier survival curves, with log-rank test, and Cox’s proportional hazards regression model were used to compare both groups. Results: Atotal of 331 patients completed the study: 167 in the control group and 164in the study group. Pressure-ulcer incidence during the study was 7.32% inthe intervention group versus 17.37% in the placebo group (p= 0,006). Theseresults show that for each 10 patients treated with Mepentol® one pressure ulcerwas prevented (NNT= 9,95). Survival curves and the regression model showeda significant statistical difference for both groups (p≤ 0,001). The averagecost of Mepentol® during the study was € 7,74. Conclusion: Mepentol® is aneffective measure for pressure ulcer prevention. It was more effective than agreasy placebo product, and was found to be cost-effective.Declaration ofinterest: This study was sponsored by Laboratorios Bama-Geve SA,Barcelona, Spain

Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo / Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic

Introducción: El conocimiento de la medicina popular resulta básico para el ejercicio de una medicina integrada. El empacho es una enfermedad conocida de la medicina popular cuyo estudio ha motivado diversas publicaciones, especialmente en el área iberoamericana y entre la población hispana de Estados Unidos. En la Comunidad Valenciana persiste un ritual de medicina mágico-religiosa conocido como trencar l’enfit (TE) (romper el empacho), sin paralelismo aparente entre los múltiples remedios descritos para esta dolencia. Nuestro objetivo ha sido estudiar la frecuencia y las características de la práctica de TE entre los pacientes que acuden a consultas externas de digestivo de un hospital comarcal. Pacientes y método: El ámbito geográfico fue la comarca de La Safor (Comunidad Valenciana), con 3 núcleos principales (Gandia, sede del hospital, Oliva y Tavernes de Valldigna) y 28 municipios menores. Se realizaron entrevistas de forma aleatoria a los pacientes que acudían a segundas visitas, durante 5 meses. Resultados: De los 539 pacientes entrevistados, 320 (59,4%) habían realizado TE en algún momento de su vida y un 25,0% en los 10 últimos años. La persona que realizaba el ritual fue en un 95,9% de los casos mujer. De los pacientes que habían practicado TE, 40 (12,5%) sabían realizar el ritual; de éstos 35 eran mujeres (p < 0,0001). No hubo diferencias significativas entre sexos, pero fueron más jóvenes los usuarios (media de edad ± desviación estándar: 51,8 ± 15,9 frente a 55,5 ± 17,7 años; p < 0,05). Las poblaciones pequeñas y Oliva presentaron una frecuencia del 65,6%, frente al 54,0% de Gandia y Tavernes (p < 0,005). El uso fue mayor entre las personas originarias de la Comunidad Valenciana (66,0%) que entre las procedentes de otros lugares de España (25,0%) (p < 0,0001). Los pacientes con estudios primarios o EGB-bachillerato presentaron el uso máximo de TE (el 60,5 y el 72,1%, respectivamente), frente a los analfabetos (42,1%), titulados medios (48,4%) y titulados superiores (36,0%) (p < 0,001). Los consumidores de hierbas medicinales habían practicado TE más que quienes no las consumían (el 69,0 frente al 54,3%; p < 0,001). No se encontró relación de la utilización del TE con el consumo de alcohol, tabaco y medicamentos en general, pero sí con el de psicofármacos (el 69,8 frente al 55,4%; p < 0,005). No hubo relación clara con los grandes grupos diagnósticos ni con el carácter funcional/orgánico de la enfermedad digestiva estudiada. El análisis multivariante (regresión logística) confirmó la asociación independiente de las variables significativas en el estudio univariante. Conclusión: Se corrobora una elevada utilización y considerable vigencia de TE entre los pacientes que acuden a consultas externas de digestivo de La Safor. Se constata una amplia difusión de las personas «expertas» en la realización de TE, con predominio casi absoluto del sexo femenino. El perfil de máximo uso de TE se podría acercar al siguiente: varón o mujer, menor de 60 años, de origen valenciano, con estudios medios-primarios, residente en determinadas poblaciones (en general, pequeñas), consumidor/a de psicofármacos y de hierbas medicinales

Introduction: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as «trencar l’enfit» (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. Objectives: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. Patients and method: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. Results: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 ± 15.9 versus. 55.5 ± 17.7 years ± SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). Conclusion: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. «Experts» in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs