[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.

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

[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.