title: Episodes of voluntary total fasting (hunger strike) in Spanish prisons: A descriptive analysis.
abstract: OBJECTIVE
  To provide a description of the frequency and main features of the episodes of voluntary total fasting (VTF) taking place in Spanish prisons.
  
  
  METHODS
  Information on the episodes of VTF reported between 04/01/2013 and 03/31/2014 was gathered. Once the appropriate informed consent was given, other data on social, demographic, penitentiary and clinical aspects were collected. A descriptive study of such variables together with a bivariate analysis was then carried out by means of standard statistical techniques and binary logistic regression models. IBM SPSS Statistics v.20 software was used for this purpose. This study was approved by an accredited Clinical Research Ethics Committee.
  
  
  RESULTS
  354 episodes of VTF took place among an average population of 29,762 prisoners. Therefore, the incidence rate was 11.9 VTF episodes per ‰ inmates-year. Informed consent (IC) was given in 180 cases (50.8%). 114 were of Spanish nationality and the average age was 38.7 years old (95% CI 37.2-40.1). The median duration of the episodes was 3 days (IQR 1-10), ranged between 1 and 71 days. The main reason was a disagreement on the decisions of treatment groups (57 cases, 31.7%). The average weight loss was 1.3 kg (70.8 vs. 69.5; p < 0.0001) and 0.7 of the BMI (24.5 vs. 23.8; p < 0.0001). 60 prisoners (33.3%) lost no weight at all and only 8 (4.4%) lost over 12% of the basal weight (8.5 kg). Ketone smell was identified in 61 cases (33.9%) and ketonuria in 63 (35%).
  
  
  CONCLUSIONS
  Only one third of those who go on hunger strike in prison actually fast. Revindicative episodes of voluntary total fasting are somewhat common in Spanish prisons, but rarely are they carried out rigorously and entail a risk for those who fast.
authors.affiliation: Penitentiary Facility Castellón I, Crtra de Alcora Km 10, 12006 Castellón de la Plana, Castellón, Spain. Electronic address: garciaj@comcas.es.
authors.forename: J
authors.initials: J
authors.lastname: García-Guerrero
authors.affiliation: Penitentiary Facility Castellón I, Crtra de Alcora Km 10, 12006 Castellón de la Plana, Castellón, Spain. Electronic address: enriquevera@ono.com.
authors.forename: E J
authors.initials: EJ
authors.lastname: Vera-Remartínez
mesh_terms: D000328:Adult; D034462:Dissent and Disputes; D005215:Fasting; D006801:Humans; D007662:Ketosis / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D015431:Weight Loss
keywords: Emanciation; Hunger strike; Incidence; Prison; Prisoners; Spain