IntroductionNutritional screening is a fundamental aspect of the initial evaluation of the hospitalised patient. Body Mass Index (BMI) in association with other parameters is a good marker of malnutrition (<18.5 kg/m2), but it presents the handicap that the great majority of patients cannot be weighed and measured. For this reason it is necessary to find other indicators that can be measured in these patients.Objectives1) Analyse the relationship between BMI and Mid-Upper Arm Circumference (MUAC); 2) establish a cut-off point of MUAC equivalent to BMI <18.5 kg/m2.Materials and MethodsThe anthropometric data of patients hospitalised over the period 2004–2013 were retrospectively revised. The following variables were collected: weight, height, BMI, MUAC, sex and age.Results1373 patients were evaluated, who presented a mean weight of: 65.04±15.51 kg; height: 1.66±0.09 m; BMI: 23.48±5.03 kg/m2; MUAC: 26.95±4.50 cm; age: 56.24±16.77. MUAC correlates suitably to BMI by means of the following equation (simple linear regression): BMI = − 0.042 + 0.873 x MUAC (cm) (R2 = 0.609), with a Pearson r value of 0.78 (p<0.001). The area under the curve of MUAC for the diagnosis of malnutrition was 0.92 (95% CI: 0.90–0.94; p<0.001). The MUAC value ≤22.5 cm presented a sensitivity of 67.7%, specificity of 94.5%, and a correct classification of 90%. No significant statistical differences were found in the cut-off point of MUAC for the diagnosis of malnutrition based on sex (p = 0.115) and age (p = 0.694).Conclusions1) MUAC correlates positively and significantly with BMI. 2) MUAC ≤ 22.5 cm correlates properly with a BMI of <18.5 kg/m2, independent of the age or sex of the patient, although there are other alternatives. MUAC constitutes a useful tool as a marker of malnutrition, fundamentally in patients for whom weight and height cannot be determined.

Objective: To analyse the association between serum C-peptide and coronary artery disease in the general population. Methods: Follow-up study of 6630 adults from the general population. They were stratified into group 1 (no insulin resistance: C-peptide < third tercile and glycaemia < 100 mg/dL), group 2 (initial insulin resistance: C-peptide ⩾ third tercile and glycaemia < 100 mg/dL) and group 3 (advanced insulin resistance: glycaemia ⩾ 100 mg/dL). Results: After 3.5 years of follow-up, group 2 had a higher incidence of myocardial infarction (relative risk (RR) = 4.2, 95% confidence interval (CI) = 1.7-10.6) and coronary artery disease (RR = 3.5, 95% CI = 1.9-6.6) than group 1. Group 3 also had increased incidences of both diseases. In multivariable analysis of the entire population, groups 2 and 3 showed significant risks of myocardial infarction and coronary artery disease (RR > 3 and RR > 2, respectively). However, when people with diabetes were excluded, the increased risks were corroborated only in group 2 for myocardial infarction (RR = 2.8, 95% CI = 1.1-6.9; p = 0.025) and coronary artery disease (RR = 2.4, 95% CI = 1.3-4.6; p = 0.007). Conclusion: Elevated C-peptide is associated with the incidence of myocardial infarction and coronary artery disease in the general population. It can be an earlier predictor of coronary events than impaired fasting glucose.

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of "Psychiatric Reform", had produced as it most significant achievements: (i) the development of a new organizational structure for mental health care, (ii) the integration of psychiatric patients in the general health care system, (iii) the creation of an extensive community network of mental health centers, and (iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that (i) many of the criticisms leveled at deinstitutionalization are not aimed at its "conceptual core" but stem from its inadequate implementation, and (ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Resistin may be a risk marker for ischemic heart disease in the general population. The serum resistin concentration is higher in women, and the associated increase in the risk of AMI based on the resistin level is also higher in women than in men.

Objective: The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services. Method: This paper is based on official administrative reports and on relevant related publications. Results: The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies. Conclusion: Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long‐term commitments, which in a system such as Spain’s must come from central administration and also from the autonomous communities.

In primary care, mental illness constitutes a major health problem. Despite this fact, GPs do not recognise a substantial proportion of these health problems.

Análisis del grado de satisfacción alimentaria percibido por los pacientes en un hospital de tercer nivel Assessment of the level of alimentary satisfaction received by patients in a tertiary hospital AbstractIntroduction: Food is a key element of nutritional support of hospitalized patients. To assess the level of food acceptance is essential to fi ght hospitalary malnutrition. Aims: a) To determine the level of satisfaction of patients to our diets; and b) to analyse variables associated with a higher level of satisfaction (appetite and type of diet). Material and methods: Cross-sectional descriptive study. A survey was used, including socio-demographic data, qualitative data as well as the overall assessment of the patient. The global level of satisfaction was compared depending on the appetite and on the type of diet (therapeutic versus basal; with salt versus unsalted) (non-parametric Krustal-Wallis test and T-students for independent samples, respectively). Results: One thousand four hundred and thirteen patients. Age: 53.9 ± 19 year old; 51.3% women. Therapeutic diet (34.9%). Only 39.4% took a salted diet. The 66.8% confi rmed previous admissions. Food hospital for 43% of patients was "as expected", while for 44.1% "better than it was expected". Meal times were adequate for 89.1% and the time for eating enough in 96.4%. About the food served, the percentage of patients who considered as good or very good: taste (56.3%), smell (65.5%), cooked (69.2%), variety (67.6%), temperature (70.4%). The global assessment of food on scale 1 to 10 was 6.8 ± 2.3. The appetite was associated with a signifi cant increase in global food patient satisfaction (p < 0.01). The type of diet or the presence of salt were not related to a relevant increase of satisfaction with the patient's diet (p = 0.99 y 0.35, respectively). Conclusions: Although the level of satisfaction of our hospital diet is reasonable, we should introduce improvements which enhance its acceptance. Appetite is associated with a signifi cant increase in global food satisfaction. The presence of salt or the type of diet (basal versus therapeutic) is not related to an outstanding improvement of the overall assessment of the diet.

The process of conveyance with the Deprivation of Liberty Safeguards (DoLS) is an important issue. 1 Conveyance can involve restraint, which does not usually amount to a deprivation of liberty and is covered by the Mental Capacity Act 2005, Sections 5 and 6. Paragraphs 2.14 and 2.15 of the Deprivation of Liberty Safeguards Code of Practice 2 attempt to deal with this issue, although it is worth examining recent case law for an answer. In DCC v KH (2009) 3 it was suggested that a standard authorisation would be sufficient to return an individual to the care home or hospital (from a place of residence), where the deprivation of liberty has been authorised, without any additional authority. 4 This judgment suggests that permission from the court is not required when returning somebody to where there is a standard authorisation for them to be deprived of their liberty. The DoLS Code of Practice states: 'In almost all cases, it is likely that a person can be lawfully taken to a hospital or a care home under the wider provisions of the Act, as long as it is considered that being in the hospital or care home will be in their best interests' (par. 2.14). Notably, paragraph 2.15 of the Code describes 'exceptional circumstances' when conveyance could amount to a deprivation of liberty and an order from the Court of Protection (to provide a residence order) would be necessary. With the majority of complaints regarding the Court of Protection originating from the length of the process and delays, 5 effective planning for conveyance is advisable.