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Monkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various parts of the body.This was an observational, prospective, multicentre study of outpatients diagnosed with monkeypox in two hospitals and two sexual health clinics in Spain between June 28, 2022, and Sept 22, 2022. Men and women aged over 18 years were eligible if they reported having symptom onset within the previous 10 days of presentation, and were ineligible if disease was severe enough to be admitted to hospital. Samples were collected from five body locations (skin lesions, oropharynx, rectum, semen or vagina, and a dried blood spot) at six time points up to 57 days after the screening visit. Samples were analysed by quantitative PCR and a subset by cell culture. The primary endpoint was time from symptom onset to viral DNA clearance.Overall, 1663 samples were collected from 77 study participants. 75 (97%) participants were men, the median age was 35·0 years (IQR 29·0-46·0), and 39 (51%) participants were living with HIV. The median time from symptom onset to viral clearance was 25 days (95% CI 23-28) in the skin lesions, 16 days (13-19) in the oropharynx, 16 days (13-23) in the rectum, 13 days in semen (9-18), and 1 day in blood (0-5). The time from symptom onset to viral clearance for 90% of cases was 41 days (95% CI 34-47) in skin lesions and 39 days (27-56) in semen. The median viral load in skin lesions was 7·3 logIn immunocompetent patients with mild monkeypox disease, PCR data alone would suggest a contact isolation period of 3 to 6 weeks but, based on detection of replication-competent virus, this time could be reduced. Based on findings from this cohort of patients, semen testing and prolonged use of condoms after recovery from monkeypox might not be necessary.University Hospital Germans Trias i Pujol and the YoMeCorono.For the Spanish translation of the abstract see Supplementary Materials section.

La investigación tuvo como objetivo propiciar una dinámica de construcción y recuperación de la memoria histórica que identifique y documente las voces de las víctimas del conflicto armado del corregimiento de Riachuelo, Santander; a través de la metodología investigación acción participativa de corte cualitativo y usando como instrumentos de recolección de información la observación, entrevista semiestructurada y talleres colectivos. Como resultado se presenta la caracterización de las narraciones que los habitantes del corregimiento hacen sobre tres lugares representativos del territorio y en los cuales, durante el conflicto, ejercieron control los grupos paramilitares. En la actualidad los habitantes del corregimiento se tornan renuentes a conversar sobre el pasado violento, dadas las diferentes interpretaciones y afectaciones que este dejó; no obstante, comparten narraciones sobre El Salto, el colegio y la iglesia como interpretaciones culturales, soslayando significados más profundos a través de narraciones mítico-religiosas.

D2:D4; Prader–Willi syndrome; Epigenetic D2:D4; Síndrome de Prader-Willi; Epigenètica D2:D4; Síndrome de Prader-Willi; Epigenética Prader-Willi syndrome (PWS) is a genetic disorder produced by a lack of expression of paternally derived genes in the 15q11-13 region. Research has generally focused on its genetic and behavioral expression, but only a few studies have examined epigenetic influences. Prenatal testosterone or the maternal testosterone-to-estradiol ratio (MaTtEr) has been suggested to play an important role in the development of the 'social brain' during pregnancy. Some studies propose the 2D:4D digit ratio of the hand as an indirect MaTtEr measure. The relationship between social performance and MaTtEr has been studied in other neurodevelopmental conditions such as Autism Spectrum Disorder (ASD), but to our best knowledge, it has never been studied in PWS. Therefore, our study aims to clarify the possible existence of a relationship between social performance-as measured using the Social Responsiveness Scale (SRS)-and MaTtEr levels using the 2D:4D ratio. We found that, as a group, PWS individuals have shorter index and ring fingers than the control group, but no significant difference in the 2D:4D ratios. The 2D:4D ratio showed a correlation only with Restricted Interests and Repetitive Behavior Subscale, where a positive correlation only for male individuals with PWS was found. Considering only PWS with previous GH treatment during childhood/adolescence (PWS-GH), index and ring fingers did not show differences in length with the control group, but the 2D:4D ratio was significantly higher in the right or dominant hand compared to controls. Support of the Spanish Ministry of Science and Innovation/ISCIII/FEDER (PI21/01148); and J.C. thanks the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya (2017 SGR 1412); the CERCA program of the I3PT; the Instituto de Salud Carlos III; and the CIBER of Mental Health (CIBERSAM).

El siguiente artículo presenta los principales resultados de la investigación Análisis de estrategias didácticas desarrolladas por los docentes de la provincia de Guanentá para educar en competencias ciudadanas.: un conjunto de estrategias didácticas pertinentes para educar en competencias ciudadanas y una comunidad de docentes dispuestos a reflexionar sobre sus prácticas pedagógicas y comprometida con la educación en competencias ciudadanas. Para hacerlo en un primer momento mostrará los fundamentos teóricos de la investigación, entre los cuales sobresalen las competencias y manifestaciones de ciudadanía, las estrategias didácticas y la mediación docente; en un segundo momento comentará el conjunto de estrategias didácticas que analizó durante tres años, enfocando su atención en aquellas que cumplieron con el recorrido y en la relevancia de la práctica docente. Por último, expresará algunas consideraciones sobre la relevancia del enfoque de investigación acción en el ámbito educativo y señalará características positivas de la educación en competencias ciudadanas.

The COVID-19 pandemic has caused a remarkable psychological overwhelming and an increase of stressors that may trigger suicidal behaviors. However, its impact on the rate of suicidal behaviors has been poorly reported. We conducted a population-based retrospective analysis of all suicidal behaviors attended in healthcare centers of Catalonia (North-East Spain; 7.5-million inhabitants) between January 2017 and June 2022. We retrieved data from the episode, including an assessment of suicide risk and the individual’s socioeconomic and clinical characteristics. Data were summarized yearly and for the periods before and after the onset of the COVID-19 pandemic in Spain in March 2020. The analysis included 26,458 episodes of suicidal behavior (21,920 individuals); of them, 16,414 (62.0%) were suicide attempts. The monthly moving average ranged between 300 and 400 episodes until July 2020, and progressively increased to over 600 episodes monthly. In the post-pandemic period, suicidal ideation increased at the expense of suicidal attempts. Cases showed a lower suicide risk; the percentage of females and younger individuals increased, whereas the prevalence of classical risk factors, such as living alone or lacking a family network and a history of psychiatric diagnosis, decreased. In summary, suicidal behaviors have increased during the COVID-19 pandemic, with more episodes of suicidal ideations without attempt and younger and lower risk profiles.

In the parameter estimation of limit extreme value distributions, most employed methods only use some of the available data. Using the peaks-over-threshold method for Generalized Pareto Distribution (GPD), only the observations above a certain threshold are considered; therefore, a big amount of information is wasted. The aim of this work is to make the most of the information provided by the observations in order to improve the accuracy of Bayesian parameter estimation. We present two new Bayesian methods to estimate the parameters of the GPD, taking into account the whole data set from the baseline distribution and the existing relations between the baseline and the limit GPD parameters in order to define highly informative priors. We make a comparison between the Bayesian Metropolis–Hastings algorithm with data over the threshold and the new methods when the baseline distribution is a stable distribution, whose properties assure we can reduce the problem to study standard distributions and also allow us to propose new estimators for the parameters of the tail distribution. Specifically, three cases of stable distributions were considered: Normal, Lévy and Cauchy distributions, as main examples of the different behaviors of the tails of a distribution. Nevertheless, the methods would be applicable to many other baseline distributions through finding relations between baseline and GPD parameters via studies of simulations. To illustrate this situation, we study the application of the methods with real data of air pollution in Badajoz (Spain), whose baseline distribution fits a Gamma, and show that the baseline methods improve estimates compared to the Bayesian Metropolis–Hastings algorithm.

Although various studies have investigated symptoms of autism spectrum disorder (ASD) in Prader–Willi syndrome (PWS), little is known about the consequences of these symptoms, especially in psychosocial function. We aimed to explore ASD symptoms in adults with PWS with special attention to psychosocial functionality. This cross-sectional study included 26 adults (15 women) with PWS who attended a reference unit for rare diseases. Participants’ primary caregivers completed the Social Responsiveness Scale (SRS), and clinicians assessed multidimensional functioning with the Personal and Social Performance Scale (PSP). Impaired social responsiveness was identified in 20 (76.9%) participants, and manifest to marked difficulties in social functioning were identified in 13 (50%). Participants with impaired social responsiveness (SRS ≥ 60) had significantly worse scores in functionality measured with the PSP (U = 12.5; p = 0.009) and with three of the four PSP main areas. Moreover, scores for the Social Cognition domain of the SRS correlated positively with the Socially useful activities (p < 0.05) and Personal and social relationships (p < 0.01) main areas of the PSP. These results suggest that difficulties in social skills should be assessed in all psychosocial evaluations of patients with PWS.

Online streaming series ‘Thirteen Reasons Why’ (13RW), released in March 2017, was criticized for its sensationalist portrayal of the main character’s suicide, leading some people to voice fears of a global contagion of self-harm behaviors. The current investigation provides a systematic review of original studies analyzing the role of 13RW as an influencing factor for suicide. Articles were identified through a systematic search of Medline, Web of Science, Scopus, PsycInfo, and a manual search of reference lists from inception until the 16 January 2023. Twenty-seven published articles were identified from an initial search of 496 studies. The positive effects of watching 13RW included a reduction in suicide stigma and a greater likelihood to discuss mental health concerns and seek for help. However, several studies reported negative outcomes, including significant increases in the rate of deaths by suicide in adolescents, the number of admissions for suicidal reasons, and the prevalence and severity of suicidal ideation and self-harm behaviors in vulnerable viewers. Still, due to methodological limitations, no causal relationship could be established. Preventive measures are required to alert of the risk and should be particularly addressed to susceptible subjects. Psychoeducational programs should be focused on this kind of phenomena in vulnerable populations.

The COVID-19 pandemic has caused remarkable psychological overwhelming and an increase in stressors that may trigger suicidal behaviors. However, its impact on the rate of suicidal behaviors has been poorly reported. We conducted a population-based retrospective analysis of all suicidal behaviors attended in healthcare centers of Catalonia (northeast Spain; 7.5 million inhabitants) between January 2017 and June 2022 (secondary use of data routinely reported to central suicide and diagnosis registries). We retrieved data from this period, including an assessment of suicide risk and individuals’ socioeconomic as well as clinical characteristics. Data were summarized yearly and for the periods before and after the onset of the COVID-19 pandemic in Spain in March 2020. The analysis included 26,458 episodes of suicidal behavior (21,920 individuals); of these, 16,414 (62.0%) were suicide attempts. The monthly moving average ranged between 300 and 400 episodes until July 2020, and progressively increased to over 600 episodes monthly. In the postpandemic period, suicidal ideation increased at the expense of suicidal attempts. Cases showed a lower suicide risk; the percentage of females and younger individuals increased, whereas the prevalence of classical risk factors, such as living alone, lacking a family network, and a history of psychiatric diagnosis, decreased. In summary, suicidal behaviors have increased during the COVID-19 pandemic, with more episodes of suicidal ideation without attempts in addition to younger and lower risk profiles.

A Bayesian hierarchical framework with a Gaussian copula and a generalized extreme value (GEV) marginal distribution is proposed for the description of spatial dependencies in data. This spatial copula model was applied to extreme summer temperatures over the Extremadura Region, in the southwest of Spain, during the period 1980–2015, and compared with the spatial noncopula model. The Bayesian hierarchical model was implemented with a Monte Carlo Markov Chain (MCMC) method that allows the distribution of the model’s parameters to be estimated. The results show the GEV distribution’s shape parameter to take constant negative values, the location parameter to be altitude dependent, and the scale parameter values to be concentrated around the same value throughout the region. Further, the spatial copula model chosen presents lower deviance information criterion (DIC) values when spatial distributions are assumed for the GEV distribution’s location and scale parameters than when the scale parameter is taken to be constant over the region.

A transformation of the Welch statistic to compare means is proposed to correct skewness and kurtosis of parent populations. The results show that this transformation seems to improve the performance of the test in heavy-tailed distributions more than other transformations focused only on skewness. The proposed test outperforms the Welch test in asymmetric heavy-tailed distributions with high heteroscedasticity and it behaves better than the Johnson’s transformation trimmed mean Welch test in normal, near-normal and light-tailed distributions. It may also be a better option when some of the distributions are heavy-tailed and some light-tailed.

Descripción precisa de los objetivos: estudios previos han señalado una tendencia global al incremento del consumo de alcohol coincidiendo con la pandemia por COVID-19, aunque la demanda asistencial por esta causa ha variado según el entorno y las políticas sanitarias. El objetivo del presente estudio es analizar el efecto de la pandemia sobre el número de asistencias relacionadas con el alcohol (ARA) en Urgencias. Material y métodos: diseño longitudinal retrospectivo. Se ha realizado una revisión mensual de todas las ARA atendidas en Urgencias del Hospital Parc Taulí (Sabadell) durante el período pre-COVID (marzo 2019 a febrero 2020) y COVID (marzo 2020 a febrero 2021). Definición de ARA: (1) motivo de consulta relacionado con el alcohol, registrado por Enfermería en el momento del triaje; o (2) diagnóstico principal relacionado con el alcohol, registrado por el/la médico/a en el momento del alta. La información obtenida se ha cuantificado tanto en términos absolutos (número de ARA) como relativos (número de ARA sobre el total de visitas en Urgencias) y, posteriormente, se han comparado ambos períodos mediante un test de Mann-Whitney. Resultados y conclusiones: durante la época COVID, se ha confirmado una reducción del número de ARA (p

"Medical students are close in their daily work with the world of suffering and death, living with pain and loss, without having received in general any regulated preparation to face it. This lack of training is associated with a sociocultural context that avoids speaking or approaching death, making it difficult for the medical student and the professionals themselves to develop the concept of death, adequate coping strategies, talking about complex decision-making at the end of life, acceptance of limitations or more generally to palliative medicine. This fear of death can hinder ethical decision-making and end-of-life conversations. The aim of the study is to assess fear of death in a sample of medical students, from 1998 to 2019, the relationship between fear of death and age, gender, course, beliefs or experiences of death and assess the evolution of death during these 20 years. Method The study included 756 medical students, from the courses between 1998 and 2019, who were given Collet-Lester revised Scale of Fear of Death and a questionnaire of sociodemographic and biographical variables. Results The analysis of the variables surveyed indicates that medical students present an intermediate level of fear of death and the process of dying. Fear of death has increased in these decades; it also increases during medical courses. Conclusions With the results obtained, medical schools should include a more oriented a specific approach in death and suffering that allows the medical student to obtain greater knowledge and be trained in accompanying death and talking about death. "

LA EDUCACIÓN, LA EMPRESA Y LA SOCIEDAD UNA MIRADA TRANSDICIPLINARIA TOMO DOS COLECCIÓN RESULTADO DE INVESTIGACIÓN Primera Edición 2020 Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia – EIDEC www.eidec.com.co Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET www.ceincet.com Red de Investigación en Educación, Empresa y Sociedad – REDIEES www.rediee.org Editorial EIDEC NIT 900583173-1 Sello editorial (978-958-52636) ISBN: 978-958-53018-0-1 DOI: https://doi.org/10.34893/4p43-7433 Fecha Publicación: 2020-10-23 comiteeditorial@editorialeidec.com www.editorialeidec.com Colombia

LA EDUCACIÓN, LA EMPRESA Y LA SOCIEDAD UNA MIRADA TRANSDICIPLINARIA TOMO DOS COLECCIÓN RESULTADO DE INVESTIGACIÓN Primera Edición 2020 Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia – EIDEC www.eidec.com.co Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET www.ceincet.com Red de Investigación en Educación, Empresa y Sociedad – REDIEES www.rediee.org Editorial EIDEC Sello editorial (978-958-52636) ISBN: 978-958-53018-0-1 DOI: https://doi.org/10.34893/4p43-7433 Fecha Publicación: 2020-10-23 comiteeditorial@editorialeidec.com www.editorialeidec.com Colombia

[This corrects the article DOI: 10.1371/journal.pone.0208112.].

Resumen Introducción: Las bombas de infusión inteligentes, constituyen una herramienta útil para la administración segura de medicamentos endovenosos dado que permiten prevenir potenciales eventos adversos. Objetivo: Evaluar la adherencia y los potenciales eventos adversos prevenidos, durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes. Metodología: Estudio observacional, realizado en cuatro unidades de cuidados intensivos usando datos del software Hospira MedNetTM. Un análisis descriptivo fue llevado a cabo junto con un análisis bivariado empleando una prueba U de Mann-Whitney, una prueba de Kruskal-Wallis y un test de Bonferroni para evaluar la adherencia y los potenciales eventos adversos prevenidos por año y servicio. Resultados: La adherencia fue del 74,0%, se presentaron 78.299 alertas de seguridad y se previnieron 4,54% (n=16.288) potenciales eventos adversos. Se encontraron diferencias entre el primer y segundo año en la adherencia [Mediana: 69,15 (Q1:64,2-Q3:75,5) Vs Mediana: 84,2(Q1:72,15-Q3:89,05), p

The study allows us to identify the effect of observer training on pro-social and assertive behaviors in school bullying in a school in the city of Bogota located in the town of Bosa. 64 students were taken between 12-14 years of 6th, 7th and 8th grade of high school, selected by sampling by conglomerates. The design was quasi- experimental pre-test post-test with control group. The Questionnaire on Intimidation and Maltreatment between Equals was applied- INSEBULL (Aviles & Elices, 2007) selecting the population and homogenizing the groups, participants were linked by random assignment in groups. The Scale of pro-social skills for adolescents EHPA (Morales & Suarez, 2011) and the Assertive Behavior Scale for Children (CABS) (Wood,1978) was applied, from the above the GE training was developed, evaluating it through the post-test of the INSEBULL, EPHA and CABS. The results allow to reject the hypothesis of work established for the study, and the null hypothesis is accepted, which specifies that the training in observers in pro-social and assertive behaviors does not establish significant differences in their measurements, for which no changes are observed. in the dynamics of the phenomenon of School Bullying.

Se han diseñado unas lecciones interactivas con el paquete swirl de R que hacen un recorrido por el temario de una asignatura de Estadística. Estas lecciones incluyen explicaciones que pueden apoyarse en esquemas o gráficos junto con ejemplos realizados por los estudiantes para reforzar las explicaciones y problemas para practicar. El contenido se desarrolla de forma secuencial, sin posibilidad de saltar ninguna pregunta, y con penalización en las respuestas incorrectas que deben ser corregidas por el propio estudiante para poder continuar. Las lecciones han sido un trabajo extra para los estudiantes, pero ha sido bonificado para incentivar su realización y con una pauta temporal. Los resultados obtenidos están en sintonía con el consenso generalizado en la literatura que apoya la mejora de los resultados académicos con el uso de actividades mejoradas por la tecnología.

El presente estudio tuvo como objeto diseñar y evaluar la eficacia de un tratamiento cognitivo-conductual breve, con el fin de disminuir las agresiones verbales y/o físicas, la reciprocidad negativa y aumentar la reciprocidad positiva; las variaciones se determinaron a través de autoregistros de frecuencia. La muestra estuvo conformada por cinco parejas que presentaban comportamientos violentos, las cuales fueron remitidas por los entes jurídicos. El estudio fue caso único de dos fases B-A y seguimiento a los 15 días. Los datos fueron analizados por la observación de gráficos de frecuencia, determinando media y desviación estándar. Los resultados mostraron que las agresiones físicas y verbales, así como la reciprocidad negativa, disminuyeron tras la fase de tratamiento, mientras que la reciprocidad positiva aumentó.

Background and aim Treatment of hepatitis C with direct-acting antiviral agents (DAA) has few side effects. Although pivotal studies suggested that DAA were safe in patients with psychiatric diseases who could not be treated with previous antiviral therapies, their effects on anxiety and depression have not yet been analysed in clinical practice. The aim of our study was to analyse anxiety and depression in the setting of DAA treatment in a clinical practice series. Methods All patients starting DAA treatment between November 1, 2014 and October 31, 2015 were eligible. Patients completed the Hospital Anxiety and Depression scale at different times during treatment. The results were plotted on line graphs and evaluated using a linear regression model with repeated measures. Results One hundred and forty-five patients were included (11% with major psychiatric disorders; 32% on psychiatric treatment). Sustained virologic response (SVR) was achieved in 97.3% of cases. Anxiety and depression measures did not differ between time points. No differences between patients on psychiatric treatment or with advanced fibrosis or cirrhosis were found at any time point analysed. Conclusion DAA treatment had no impact on anxiety or depression during or after chronic hepatitis C infection treatment, even in high-risk patients with major psychiatric disorders.

IntroductioneHealth is a new approach for managing several health conditions, but up to now not so many interventions have shown their efficacy/effectiveness. The AUTAPP Project tries to add knowledge in eHealth interventions targeted to Mental Health disorders, specifically Autism Spectrum Disorder (ASD) management that requires complex interventions that integrate different psychosocial interventions. AUTAPP aims to develop an evidence based Clinical Decision Support System (CDSS) using mobile technology for improving the decision process on psychosocial therapies in ASD. This study aimed to identify recommendations on which the algorithm of the CDSS will be developed.MethodsA systematic review (November 2009-November 2018) was carried out to identify the existing scientific evidence published in relation to the effectiveness of: (i) early detection protocols; (ii) assessment tools; (iii) existing non-pharmacological therapies. Main databases were consulted (PubMed, Cochrane Library, PsychoInfo). Articles were reviewed by two independent reviewers. The quality of included publications and recommendations were assessed according to SIGN criteria.ResultsA total number of 147 publications were included (477 identified): 96 for non-pharmacological therapies, 33 for assessment tools and eighteen for early detection. Regarding early detection and assessment, 12 recommendations were identified and six obtained the highest level (A), such as the convenience of multidisciplinary diagnosis teams and the usefulness of the Modified Checklist for Autism in Toddlers (M-CHAT) for ASD confirmation. For non-pharmacological therapies, 16 recommendations were collected. Those with higher levels of recommendations were family, environmental and educational (three As and one B). Interventions with lower levels of recommendation (C) were interventions which exercise, computers and neurological approaches.ConclusionsThis systematic review allows both to identify gaps and opportunities in psychosocial interventions research and be the base for the CDSS algorithm. In the future professionals, careers and people diagnosed with ASD will validate the mobile CDSS.

Objetivos: proporcionar orientaciones conceptuales y prácticas a cuidadores, maestros, profesionales que trabajen con población infantil y comunidad en general respecto a es - trategias inclusivas acertadas para el niño con discapacidad (cero a doce años). Para ello se mencionan algunas herramientas prácticas (procedimientos, instrumentos, estrategias, adecuaciones), cuya utilización ayuda a comprender la situación y a mejorar la participación del niño en contextos de desempeño ocupacional cotidiano: hogar, escuela, actividades de juego y de tiempo libre. En últimas, se espera favorecer una participación más efectiva del niño en sus ambientes y roles ocupacionales, al reconocer las demandas de estos, así como el manejo más acertado, desde la perspectiva profesional de Terapia Ocupacional. Materiales: metodológicamente, este estudio rastreó fuentes especializadas nacionales e internacionales de Terapia Ocupacional desde el año 2000 sobre tres conceptos clave: niños con discapacidad, desempeño ocupacional y estrategias inclusivas. En cada fuente se identificaron las estrategias de inclusión propuestas para favorecer la participación del niño en ocupaciones cotidianas. Conclusiones: se avanzó en plantear reflexiones sobre las implicaciones ocupacionales de la discapacidad en niños, en pro de favorecer dinámicas incluyentes. Los referentes conceptuales que explican la participación del niño en los ambientes y roles que le son cotidianos (hogar, escuela y disfrute de actividades lúdicas y de tiempo libre) insisten en que las acciones con esta población deben partir de reconocer las particularidades en cada caso. Al sensibilizar sobre la complejidad de la discapacidad se asume una mirada multidi - mensional y transdisciplinaria en la comprensión, atención y valoración de las necesidades de los niños con discapacidad.

Abstract. Aim: In a previous controlled study, the authors reported on the significant beneficial effects of a telephone intervention program for prevention of suicide attempts by patients for up to 1 year. This study reports the 5-year follow-up data. Outcomes were number of recurrences and time to recurrence. Method: The intervention was carried out on patients discharged from the emergency room (ER) following attempted suicide (Sabadell). It consisted of a systematic, 1-year telephone follow-up program: after 1 week, and thereafter at 1-, 3-, 6-, 9-, and 12-month intervals to assess the risk of suicide and encourage adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone contact. Results: The effect of reattempt prevention observed in the first year was not maintained over the long term. Conclusion: A telephone management program for patients discharged from an ER after attempted suicide could be considered a useful strategy in delaying further suicide attempts and reducing the rate of reattempts in the first year. However, results showed that the beneficial effects were not maintained at the 5-year follow-up.