Diagnostic evaluation of institutions as a basis for designing the Brazilian maturity model of telehealth services.

BACKGROUND: The number and specificities of telehealth service units that expanded their services and diversified with the COVID-19 pandemic in Brazil need to be discovered. The objective of this manuscript is to present a methodology for the diagnostic evaluation of 19 telehealth units from different regions of the country for federal governmental decision-making. METHODS: A cross-sectional quantitative and qualitative study was carried out in the form of a census based on administrative records with an online survey and in-depth interviews with local telehealth managers. RESULTS: Despite the discontinuity of regular funding, the results point to a diversity of initiatives and advances. Citizenship, sustainability, security, and budget management are recurring themes in the maturity analysis of telehealth services after the advent of the pandemic. CONCLUSION: It is necessary for Brazil to build a resilient model of the maturity of telehealth services that contemplates the different regional scenarios.

Deep Learning Soft-Decision GNSS Multipath Detection and Mitigation.

A technique is proposed to detect the presence of the multipath effect in Global Navigation Satellite Signal (GNSS) signals using a convolutional neural network (CNN) as the building block. The network is trained and validated, for a wide range of C/N0 values, with a realistic dataset constituted by the synthetic noisy outputs of a 2D grid of correlators associated with different Doppler frequencies and code delays (time-domain dataset). Multipath-disturbed signals are generated in agreement with the various scenarios encompassed by the adopted multipath model. It was found that pre-processing the outputs of the correlators grid with the two-dimensional Discrete Fourier Transform (frequency-domain dataset) enables the CNN to improve the accuracy relative to the time-domain dataset. Depending on the kind of CNN outputs, two strategies can then be devised to solve the equation of navigation: either remove the disturbed signal from the equation (hard decision) or process the pseudoranges with a weighted least-squares algorithm, where the entries of the weighting matrix are computed using the analog outputs of the neural network (soft decision).

Fumonisin-containing diets decrease the metabolic activity of myenteric neurons in rats.

Fumonisins are naturally occurring mycotoxins that contaminate food for human and animal consumption. They have neurotoxic effects, but the mechanisms by which these toxins affect the nervous system are not fully known. In the present study, male Wistar rats were fed between 21 and 63 days of age with diets that contained fumonisins B1+B2 at 0, 1, and 4 mg/kg. The following variables were assessed: food consumption, growth, body weight gain, and blood parameters. Morphoquantitave analyses of the most metabolically active myenteric neurons were performed, detected by NADH-diaphorase activity. Nitrergic neurons were detected by NADPH-diaphorase activity. The fumonisin-containing diets did not significantly alter food consumption or the body or plasma parameters. These diets decreased the metabolic activity of jejunal myenteric neurons, reducing neuronal density of the most metabolic active neurons by 30.8% and the cell body area by 4.3%. The diets also decreased the cell body area of nitrergic neurons by 22.1%. The effects of fumonisin B1 on the respiratory metabolism of isolated mitochondria in the brain and liver were also assessed. A decrease in oxygen consumption up to a 29% in the brain and 38% in the liver was observed in mitochondrial isolates to which 50 µM fumonisin B1 was added. The decrease in respiratory activity that was triggered by exposure to fumonisins was related to the lower metabolic activity of myenteric neurons, which had a negative impact on neuroplasticity of the enteric nervous system.

Tracking and Dynamic Tuning of a Wireless Powered Endoscopic Capsule.

This work presents an inductive wireless power transfer system for powering an endoscopy capsule supplying energy to power electronic devices allocated inside a capsule of ≈26.1 mm × 9 mm. A receiver with three coils in quadrature with dimensions of ≈9 mm × 9 mm × 10 mm is located inside the capsule, moving freely inside a transmitter coil with 380 mm diameter through translations and revolutions. The proposed system tracks the variations of the equivalent magnetic coupling coefficient compensating misalignments between the transmitter and receiver coils. The power on the load is estimated and optimized from the transmitter, and the tracking control is performed by actuating on a capacitance in the matching network and on the voltage source frequency. The proposed system can prevent load overheating by limiting the power via adjusting of the magnitude of voltage source VS. Experimental results with uncertainties analysis reveal that, even at low magnetic coupling coefficients k ranging from (1.7 × 10-3, 3.5 × 10-3), the power on the load can be held within the range of 100-130 mW. These results are achieved with any position of the capsule in the space, limited by the diameter of the transmitter coil and height of 200 mm when adjusting the series capacitance of the transmitter in the range (17.4, 19.4) pF and the frequency of the power source in the range (802.1, 809.5) kHz.

Evaluation of Deep Learning Methods in a Dual Prediction Scheme to Reduce Transmission Data in a WSN.

One of the most important challenges in Wireless Sensor Networks (WSN) is the extension of the sensors lifetime, which are battery-powered devices, through a reduction in energy consumption. Using data prediction to decrease the amount of transmitted data is one of the approaches to solve this problem. This paper provides a comparison of deep learning methods in a dual prediction scheme to reduce transmission. The structures of the models are presented along with their parameters. A comparison of the models is provided using different performance metrics, together with the percent of points transmitted per threshold, and the errors between the final data received by Base Station (BS) and the measured values. The results show that the model with better performance in the dataset was the model with Attention, saving a considerable amount of data in transmission and still maintaining a good representation of the measured data.

Exploiting the RSSI Long-Term Data of a WSN for the RF Channel Modeling in EPS Environments.

In this paper, we propose a methodology to use the received signal strength indicator (RSSI) available by the protocol stack of an installed Wireless Sensor Network (WSN) at an electric-power-system environment (EPS) as a tool for obtaining the characteristic of its communication channel. Thereby, it is possible to optimize the settings and configuration of the network after its deployment, which is usually run empirically without any previous knowledge of the channel. A study case of a hydroelectric power plant is presented, where measurements recorded over a two-month period were analyzed and treated to obtain the large-scale characteristics of the radiofrequency channel at 2.4 GHz. In addition, we showed that instantaneous RSSI data can also be used to detect specific issues in the network, such as repetitive patterns in the transmitted power level of the nodes, and information about its environment, such as the presence of external sources of electromagnetic interference. As a result, we demonstrate the practical use of the RSSI long-term data generated by the WSN for its own performance optimization and the detection of particular events in an EPS or any similar industrial environment.

What are the global patterns of microplastic ingestion by fish? A scientometric review.

The billions of tons of plastic released into the environment mostly fragment into smaller particles that reach rivers and oceans, posing toxicity risks to aquatic organisms. As fish serve as excellent environmental indicator organisms, this study aims to comprehensively review and quantify published data regarding the abundance of microplastics (MPs) ingested by fish through scientometric analysis. Systematic analysis reveals that global aquatic ecosystems are contaminated by MPs, with the characteristics of these contaminants stemming from inadequate disposal management practices. The abundance of MPs was recorded in several fish species, notably Cyprinus carpio in natural environments and Danio rerio in controlled environments. According to the surveyed studies, laboratory experiments do not accurately represent the conditions found in natural environments. The results suggest that, in natural environments, the predominant colors of MPs are blue, black, and red. Fibers emerged as the most prevalent type, with polyethylene (PE) and polypropylene (PP) being the most frequently identified chemical compositions. On the other hand, laboratory studies showed that the spheres and fragments ingested were predominantly polystyrene (PS) green, followed by the colors blue and red. This discrepancy complicates drawing accurate conclusions regarding the actual effects of plastic particles on aquatic biota. Given the enduring presence of plastic in the environment, it is imperative to consider and implement environmental monitoring for effective, long-term management.

Enhancing Fatigue Life and Strength of Adhesively Bonded Composite Joints: A Comprehensive Review.

Adhesive bonding is widely seen as the most optimal method for joining composite materials, bringing significant benefits over mechanical joining, such as lower weight and reduced stress concentrations. Adhesively bonded composite joints find extensive applications where cyclic fatigue loading takes place, but this might ultimately lead to crack damage and safety issues. Consequently, it has become essential to study how these structures behave under fatigue loads and identify the remaining gaps in knowledge to give insights into new possibilities. The fatigue life of adhesively bonded composite joints is influenced by various parameters, including joint configuration and material properties of adherends and adhesive. Numerous studies with varying outcomes have been documented in the literature. However, due to the multitude of influential factors, deriving conclusive insights from these studies for practical design purposes has proven to be challenging. Hence, this review aims to address this challenge by discussing different methods to enhance the fatigue performance of adhesively bonded composite joints. Additionally, it provides a comprehensive overview of the existing literature on adhesively bonded composite joints under cyclic fatigue loading, focusing on three main aspects: Adherends modification, adhesive modification, and joint configurations. Since the effect of modifying the adhesive, adherends, and joint configurations on fatigue performance has not been comprehensively studied in the literature, this review aims to fill this gap by compiling and comparing the relevant experimental data. Furthermore, this review discusses the challenges and limitations associated with the methods that can be used to monitor the initiation and propagation of fatigue cracks.

Use of Medical Subject Headings (MeSH) in Portuguese for categorizing web-based healthcare content.

INTRODUCTION: Internet users are increasingly using the worldwide web to search for information relating to their health. This situation makes it necessary to create specialized tools capable of supporting users in their searches. OBJECTIVE: To apply and compare strategies that were developed to investigate the use of the Portuguese version of Medical Subject Headings (MeSH) for constructing an automated classifier for Brazilian Portuguese-language web-based content within or outside of the field of healthcare, focusing on the lay public. METHODS: 3658 Brazilian web pages were used to train the classifier and 606 Brazilian web pages were used to validate it. The strategies proposed were constructed using content-based vector methods for text classification, such that Naive Bayes was used for the task of classifying vector patterns with characteristics obtained through the proposed strategies. RESULTS: A strategy named InDeCS was developed specifically to adapt MeSH for the problem that was put forward. This approach achieved better accuracy for this pattern classification task (0.94 sensitivity, specificity and area under the ROC curve). CONCLUSIONS: Because of the significant results achieved by InDeCS, this tool has been successfully applied to the Brazilian healthcare search portal known as Busca Saúde. Furthermore, it could be shown that MeSH presents important results when used for the task of classifying web-based content focusing on the lay public. It was also possible to show from this study that MeSH was able to map out mutable non-deterministic characteristics of the web.

Profile and professional expectations of medical students in Mozambique: a longitudinal study.

INTRODUCTION: This paper compares the socioeconomic profile of medical students registered at the Faculty of Medicine of Universidade Eduardo Mondlane (FM-UEM), Maputo, for the years 1998/99 and 2007/08. CASE STUDY: The objective is to describe the medical students' social and geographical origins, expectations and perceived difficulties regarding their education and professional future. Data were collected through questionnaires administered to all medical students. DISCUSSION AND EVALUATION: The response rate in 1998/99 was 51% (227/441) and 50% in 2007/08 (484/968).The main results reflect a doubling of the number of students enrolled for medical studies at the FM-UEM, associated with improved student performance (as reflected by failure rates). Nevertheless, satisfaction with the training received remains low and, now as before, students still identify lack of access to books or learning technology and inadequate teacher preparedness as major problems. CONCLUSIONS: There is a high level of commitment to public sector service. However, students, as future doctors, have very high salary expectations that will not be met by current public sector salary scales. This is reflected in an increasing degree of orientation to double sector employment after graduation.

[Emergency Psychiatric Service in general hospitals: a retrospective study]. / Serviço de Emergência Psiquiátrica em hospital geral: estudo retrospectivo.

The Emergency Psychiatric Service in General Hospitals (SEPHG, acronym in Portuguese) is a service included in the psychiatric reform movement. The purpose of the present study was to characterize patients with psychological distress treated at the Dr. Estevam SEPHG, located in Sobral, Cear state. This exploratory study was performed using documental analyses with a quantitative approach, and involved 191 clients treated at the referred SEPHG from January to December 2007. Data collection was performed using a client register book, which contained information obtained from the patients' medical record. There was a predominance of male patients (70.15%), aged 30-49 years (48.71%) and single (74.86%). Most patients were from the city of Sobral (69.64%). In 42.40% of cases, the diagnosis was of alcohol use/abuse. Most clients (66.50%) sought the service voluntarily. After being evaluated at the SEPHG, 43.45% of patients were referred to the local Center for Psychosocial Care-Alcohol and other Drugs. The results emphasize the importance of mental health.

Chronic ingestion of deoxynivalenol-contaminated diet dose-dependently decreases the area of myenteric neurons and gliocytes of rats.

BACKGROUND: Deoxynivalenol (DON), a mycotoxin produced by Fusarium spp., is commonly found in cereals ingested by humans and animals. Its ingestion is correlated with hepatic, hematologic, renal, splenic, cardiac, gastrointestinal, and neural damages, according to dose, duration of exposure and species. In this work, the effects of the ingestion of DON-contaminated diet at concentrations considered tolerable for human and animal intake were assessed. METHODS: Male Wistar rats aging 21 days were allotted to five groups that were given, for 42 days, diets contaminated with different concentrations of DON (0, 0.2, 0.75, 1.75, and 2 mg kg-1 of chow). Food ingestion, bodyweight, oxidative status and morphometric analyses of gliocytes, and neurons of jejunal myenteric ganglia were recorded. KEY RESULTS: At these concentrations, there was no food rejection, decrease in bodyweight gain, changes in oxidative status, or loss of either neurons or gliocytes. However, DON decreased gliocyte area, general neuronal population, nitrergic, cholinergic and NADH-diaphorase positive subpopulations and, as a result, ganglion area. CONCLUSIONS & INFERENCES: It was concluded that, even in the absence of visible effect, DON exposure reduces cell body area of gliocytes and neurons of the myenteric plexus of the rat jejunum.

Avocado (Persea americana) pulp improves cardiovascular and autonomic recovery following submaximal running: a crossover, randomized, double-blind and placebo-controlled trial.

Previous studies have demonstrated that regular avocado consumption presents advantageous effects on cardiovascular system. However, little attention has been paid to the use of avocado as a dietary supplement, in particular, for individuals involved in physical exercise training. Therefore, this study aims to evaluate the effect of acute avocado pulp intake on cardiovascular and autonomic recovery subsequent to moderate exercise. Using a crossover, randomized, double-blind and placebo-controlled trial design, 16 healthy female adults underwent two protocols: Avocado pulp (600 mg in capsule) and placebo (600 mg starch in capsule). After the ingestion of Avocado pulp or placebo, the subjects were seated for 60 min at rest, followed by running on a treadmill at a submaximal level and then remained seated for 60 min during recovery from the exercise. Heart rate (HR), heart rate variability (HRV) [rMSSD, SD1, HF (ms2)] and skin conductance were evaluated before and during exercise, as well as during recovery. HR, systolic blood pressure, HRV and skin conductance recovered faster when subjects were given avocado pulp prior to exercise. In conclusion, avocado pulp improved cardiovascular and autonomic recovery after exercise, suggesting a reduced risk of cardiovascular events after exertion. The current results support the beneficial effects of ingestion of avocado prior to submaximal treadmill running.

Morphometric and quantitative study of the myenteric neurons of the stomach of malnourished aging rats.

In this work, two groups of Wistar rats were fed ad libitum, one with standard chow (22% protein) and the other with hypoproteic chow (8% protein), from the 210th to the 345th day of life. Compared to the animals fed with standard chow, the animals fed with hypoproteic chow exhibited hypophagia (ingestion about 30% lower), mean weight gain 4.46% lower, greater amount of retroperitoneal and peri-epididymal fat (19% on average), lower Lee index, decrease of total plasma proteins and plasma globulins and maintenance of plasma albumin. The quantitative and morphometric analysis of the NADH-diaphorase positive myenteric neurons yielded a larger number of small neurons and a smaller number of medium neurons in the animals subjected to the hypoproteic chow, demonstrating that the neuronal growth was affected by the diet. In the animals fed with hypoproteic chow, a 20% decrease in the NADH-diaphorase positive neurons of the forestomach and a 10% decrease in those of the glandular stomach were observed.

Comparative analysis of the expression of proliferating cell nuclear antigen, p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma.

Several epidemiologic studies have shown the malignant transformation potential of oral lichen planus; however, this potential is subject of much controversy. To evaluate the expression of proteins related to the cell proliferation and apoptosis processes in oral lichen planus, we compared oral lichen planus with oral squamous cell carcinoma. Twenty-four cases of each lesion were submitted according to streptavidin-biotin technique to evaluate the immunohistochemical expression of proliferating cell nuclear antigen, p53, bax, and bcl-2 proteins. chi(2) test showed no statistically significant differences between the expression of p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma (P > .05). However, the expression of proliferating cell nuclear antigen was significantly lower in oral lichen planus than in oral squamous cell carcinoma (P < .05). No statistically significant differences between the expression of p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma were observed, which may be an evidence of the potential of malignant transformation of oral lichen planus.

Immunohistochemical expression of PCNA, p53, bax and bcl-2 in oral lichen planus and epithelial dysplasia.

The potential for malignant transformation of oral lichen planus is still controversial. The expression of proteins related to cell proliferation and apoptosis in oral lichen planus and epithelial dysplasia was analyzed to evaluate the true potential for malignant transformation of this disease. Twenty-four cases of each lesion were subjected to the streptoavidin-biotin technique for identifying the immunohistochemical expression of PCNA, p53, bax, and bcl-2 proteins. Of the 24 cases of oral lichen planus, 14 (58.33%) were positive for PCNA, 10 (41.67%) for p53, 4 (16.67%) for bcl-2 and 12 (50%) for bax, whereas of the 24 cases of epithelial dysplasia, 20 (83.33%) were positive for PCNA, 10 (41.67%) for p53, 6 (25%) for bcl-2, and 20 (83.33%) for bax. Chi-squared test showed no statistically significant differences between the expression of p53 and bcl-2 in oral lichen planus and epithelial dysplasia, regardless of the grade (P > 0.05). However, the expression of PCNA and bax was significantly increased in epithelial dysplasia (P < 0.05). The results of this study showed that alterations in expression of these proteins are observed in oral lichen planus and epithelial dysplasia, suggesting the potential for malignant transformation in both lesions.

Comparative analysis of cell proliferation ratio in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma.

BACKGROUND: Although oral lichen planus has been classified by the World Health Organization (WHO) as a potentially malignant disorder, such classification is still the target of much controversy. AIM: To evaluate the cell proliferation rate in oral lichen planus, comparing it to the rate observed in epithelial dysplasia and oral squamous cell carcinoma, aiming at indications which might indicate the potential for malignant transformation. MATERIAL AND METHODS: Twenty-four cases of each lesion were submitted to the streptoavidin-biotin and AgNOR technique to evaluate the immunohistochemical expression of PCNA and the mean NORs/nucleus, respectively. RESULTS: Positivity for PCNA was observed in 58.33% of oral lichen planus cases, 83.33% of epithelial dysplasia cases and 91.67% of oral squamous cell carcinoma cases. Chi-squared test showed that the number of positive cases for PCNA was significantly lower in oral lichen planus than in oral squamous cell carcinoma (p<0.05). No significant statistical difference between oral lichen planus and epithelial dysplasia (p>0.05) and between the epithelial dysplasia and oral squamous cell carcinoma (p>0.05) was observed. The mean NORs/nucleus in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma were 1.74+/-0.32, 2.42+/-0.62 e 2.41+/-0.61, respectively. Variance analysis (ANOVA) revealed significant statistical difference between oral lichen planus and the other studied lesions (p<0.05). CONCLUSION: Oral lichen planus cell proliferation rate was less than in oral epithelial dysplasia and oral squamous cell carcinoma which might explain the lower malignant transformation rate.

Comparative study of cell alterations in oral lichen planus and epidermoid carcinoma of the mouth mucosa.

UNLABELLED: Currently, much is discussed regarding the pre-malignant nature of mouth mucosa lichen planus. AIM: The present study aims at analyzing the alterations found in the epithelial cells present in the oral cavity lichen planus, comparing them to those found in epidermoid carcinoma. MATERIALS AND METHODS: Histological cross-sections of oral lichen planus and epidermoid carcinoma, dyed by hematoxylineosin, were analyzed through light microscopy. RESULT: The most frequently found alterations in oral lichen planus were: an increase in the nucleus/cytoplasm relation (93.33%), nucleus membrane thickness (86.67%) and bi-nucleus or multinucleous (86.67%). The Student t test (alpha=5%) revealed a statistically significant difference between the average number of cell alterations in oral lichen planus (5.87+/-1.57) and in epidermoid carcinoma (7.60+/-1.81). As to the types of alterations, the chi-squared test also revealed statistically significant differences among the lesions assessed in relation to the following cell alterations: nuclear excess chromatism, atypical mitoses, cellular pleomorphism and abnormal cell differentiation (p<0.05). CONCLUSION: Despite the fact that in some cases, some pathologists may make mistakes in the histopathological diagnosis of oral lichen planus, the results obtained in this study show that the alterations present in oral lichen planus differ considerably from those seen in epidermoid carcinoma, thus showing how distinct these two diseases are.

Fatores de risco de morte por dengue no Brasil: um estudo ecológico / Dengue death risk factors in Brazil: an ecological study / Factores de riesgo de muerte por dengue en Brasil: un estudio ecológico

Este artigo tem por objetivo identificar os fatores de risco de morte por dengue no Brasil. Para isso, por meio do Sistema de Informação de Agravos de Notificação (SINAN) e do Morbidade Hospitalar do Sistema Único de Saúde (SIH/SUS), foram levantados os dados referentes às mortes por dengue ocorridas no Brasil entre 1 de janeiro de 2014 a 11 de março de 2024. A partir desses dados, foram calculados os riscos relativos para as seguintes variáveis: sexo, raça, faixa etária, escolaridade e sorotipo, adotando-se o nível de significância de 5% e o intervalo de confiança de 95%. Em relação ao sexo, os homens apresentaram maior risco de morte (RR: 1,24; IC95%: 0,76­0,84) em comparação às mulheres. Quanto à raça, brancos (RR: 1,18; IC 95%: 1,12­1,25) e amarelos (RR: 1,33; IC95%: 1,07­1,66) exibiram um risco significativamente maior do que as demais. Pessoas com 60 anos ou mais apresentaram risco de morte 7,74 vezes maior (RR: 7,74; IC95%: 7,38­8,11) em comparação às outras faixas etárias. Pessoas analfabetas ou que estudaram só até a 4a série do ensino fundamental tiveram um risco três vezes maior (RR: 3,00; IC95%: 2,79­3,23) do que aquelas com mais anos de estudo. O sorotipo DENV-2, por sua vez, aumentou 1,61 vezes o risco de morte (RR: 1,61; IC95%: 1,43­1,80) em relação aos demais sorotipos, enquanto o DENV-3 aumentou 2,94 vezes (RR: 2,94; IC95%: 1,68­5,15). Foi possível deduzir que sexo, raça, faixa etária, escolaridade e sorotipo são fatores de risco de morte por dengue, devendo, portanto, ser considerados na elaboração de políticas públicas de combate à dengue.

This study investigated the dengue risk death factors in Brazil by analyzing data on dengue deaths between January 1st, 2014 to March 11, 2024, registered in the SINAN and SIH/SUS databases. Relative risks were calculated for the following variables: gender, race, age group, schooling level and serotype, adopting a 5% level of significance and 95% confidence interval. Regarding gender, men had a higher death risk (RR: 1.24; 95% CI: 0.76­0.84) than women. Whites (RR: 1.18; 95% CI: 1.12­1.25) and Asians (RR: 1.33; 95% CI: 1.07­1.66) showed a significantly higher risk than other ethnicities. People with 60 years of age or over presented death risk 7.74 times higher (RR: 7.74; IC 95%: 7.38­8.11) compared with other age groups. Illiterates or people with complete primary education had a 3 times higher risk (RR: 3.00; 95% CI: 2.79­3.23) than those with more years of study. The serotype DENV-2 increased in 1.61 times the risk of death (RR: 1.61; 95% CI: 1.43­1.80) compared with other serotypes, whereas DENV-3 serotype increased the risk by 2.94 times (RR: 2.94; 95% CI: 1.68­5.15). Gender, race, age group, schooling level and serotype are dengue death risk factors, thus they should be considered when elaborating public policies to fight the disease.

Este estudio tuvo por objetivo identificar los factores de riesgo de muerte por dengue en Brasil. Para ello, se recogieron datos de muertes por dengue en Brasil entre el 1 de enero de 2014 y el 11 de marzo de 2024 del Sistema de Información de Agravios de Notificación (SINAN) y del Sistema de Morbilidad Hospitalaria del Sistema Único de Salud (SIH/SUS). A partir de estos datos, se calcularon los riesgos relativos para las siguientes variables: sexo, raza, grupo de edad, nivel de estudios y serotipo, adoptando un nivel de significación del 5% y un intervalo de confianza del 95%. Con relación al sexo, los hombres presentaron un mayor riesgo de muerte (RR: 1,24; IC 95%: 0,76-0,84) en comparación con las mujeres. En cuanto a la raza, los blancos (RR: 1,18; IC 95%: 1,12-1,25) y los pardos (RR: 1,33; IC 95%: 1,07-1,66) tenían un riesgo significativamente mayor que los demás. Las personas de 60 años o más tenían un riesgo de muerte 7,74 veces mayor (RR: 7,74; IC 95%: 7,38-8,11) que otros grupos de edad. Las personas analfabetas o con hasta 4.º grado de la primaria tenían un riesgo 3 veces mayor (RR: 3,00; IC 95%: 2,79-3,23) que las que tenían más años de escolaridad. El serotipo DENV-2 aumentó el riesgo de muerte en 1,61 veces (RR: 1,61; IC 95%: 1,43-1,80) en comparación con los demás serotipos, mientras que el DENV-3 lo aumentó 2,94 veces (RR: 2,94; IC 95%: 1,68-5,15). El sexo, la raza, el grupo de edad, el nivel de estudios y el serotipo son factores de riesgo de muerte por dengue, por lo tanto, deben tenerse en cuenta en la elaboración de políticas públicas de lucha contra el dengue.