Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

The conservation status of the world’s reptiles

Effective and targeted conservation action requires detailed information about species, their distribution, systematics and ecology as well as the distribution of threat processes which affect them. Knowledge of reptilian diversity remains surprisingly disparate, and innovative means of gaining rapid insight into the status of reptiles are needed in order to highlight urgent conservation cases and inform environmental policy with appropriate biodiversity information in a timely manner. We present the first ever global analysis of extinction risk in reptiles, based on a random representative sample of 1500 species (16% of all currently known species). To our knowledge, our results provide the first analysis of the global conservation status and distribution patterns of reptiles and the threats affecting them, highlighting conservation priorities and knowledge gaps which need to be addressed urgently to ensure the continued survival of the world’s reptiles. Nearly one in five reptilian species are threatened with extinction, with another one in five species classed as Data Deficient. The proportion of threatened reptile species is highest in freshwater environments, tropical regions and on oceanic islands, while data deficiency was highest in tropical areas, such as Central Africa and Southeast Asia, and among fossorial reptiles. Our results emphasise the need for research attention to be focussed on tropical areas which are experiencing the most dramatic rates of habitat loss, on fossorial reptiles for which there is a chronic lack of data, and on certain taxa such as snakes for which extinction risk may currently be underestimated due to lack of population information. Conservation actions specifically need to mitigate the effects of human-induced habitat loss and harvesting, which are the predominant threats to reptiles.

Diagrama de secuencias de reducción (dsr): aproximación metodológica para el análisis de núcleos líticos y remontajes

Homenaje a Georges Laplace, realizado en Vitoria-Gasteiz el 13,14 y 15 de noviembre de 2012. Edición a cargo de Aitor Calvo, Aitor Sánchez, Maite García-Rojas y Mónica Alonso-Eguíluz.

Morphometric differentiation in small juveniles of the pink spotted shrimp (Farfantepenaeus brasiliensis) and the southern pink shrimp (F. notialis) in the Yucatan Peninsula, Mexico

The morphometric and morphological characters of the rostrum have been widely used to identify penaeid shrimp species (Heales et al., 1985; Dall et al., 1990; Pendrey et al., 1999). In this setting, one of the constraints in studies of penaeid shrimp populations has been the uncertainty in the identification of early life history stages, especially in coastal nursery habitats, where recruits and juveniles dominate the population (Dall et al., 1990; Pérez-Castañeda and Defeo, 2001). In the western Atlantic Ocean, Pérez-Farfante (1969, 1970, 1971a) described diagnostic characters of the genus Farfantepenaeus that allowed identification of individuals in the range of 8−20 mm CL (carapace length) on the basis of the following morphological features: 1) changes in the structure of the petasma and thelycum; 2) absence or presence of distomarginal spines in the ventral costa of the petasma; 3) the ratio between the keel height and the sulcus width of the sixth abdominal somite; 4) the shape and position of the rostrum with respect to the segments and flagellum of the antennule; and 5) the ratio between rostrum length (RL) and carapace length (RL/CL). In addition, she classified Farfantepenaeus into two groups according to the shape and position of the rostrum with respect to the segments and flagellum of the antennule and the ratio RL/CL: 1) F. duorarum and F. notialis: short rostrum, straight distally, and the proximodorsal margin convex, usually extending anteriorly to the end of distal antennular segment, sometimes reaching to proximal one-fourth of broadened portion of lateral antennular flagellum, with RL/CL <0.75; and 2) F. aztecus, F. brasiliensis, F. paulensis, and F. subtilis: long rostrum, usually almost straight along the entire length, extending anteriorly beyond the distal antennular segment, sometimes reaching to the distal one-third of broadened portion of lateral antennular flagellum, with RL/CL >0.80. Pérez-Farfante stressed that, for the recognition to species level of juveniles <10 mm CL, all the characters listed above should be considered because occasionally one alone may not prove to be diagnostic. However, the only characters that could be distinguished for small juveniles in the range 4−8 mm CL are those defined on the rostrum. Therefore, it has been almost impossible to identify and separate small specimens of Farfantepenaeus (Pérez-Farfante, 1970, 1971a; Pérez-Farfante and Kensley, 1997).

Estudio regional sobre las dimensiones sociales en el manejo de areas marinas protegidas: casos en Costa Rica, Nicaragua, Honduras y Panama

Explora la percepción de las personas residentes en las comunidades costeras vinculadas a los espacios marinos protegidos en Honduras, Nicaragua, Costa Rica y Panamá. Profundiza, a partir de estudios de caso y el análisis comparativo, los temas de gobernanza, derechos humanos y distribución justa y equitativa de beneficios derivados de la conservación. Los resultados destacan que los esfuerzos de conservación marina no han logrado establecer puentes que permitan satisfacer las necesidades sociales. Las comunidades han sido excluidas de los procesos de toma de decisiones, y los costos de la conservación han recaído en las pueblos costeros. Se plantean recomendaciones orientadas hacia el desarrollo de procesos de conservación marina y desarrollo local en aras de tender puentes en la búsqueda de formas y modelos de conservación marina que sean respetuosos de los derechos humanos y promuevan “el buen vivir” de las comunidades en territorios marino-costeros.

Elementos de tecnología cerámica. Misión China en Ráquira proyecto cerámica y porcelana.

34 hojas : ilustraciones, fotografías.

Investigación y elaboración artesanal de porcelana en Ráquira, sexto informe.

[272] hojas : ilustraciones, fotografías.

Cuaderno de diseño de asesorías en los oficios de tejeduría en macramé en galón de seda en Duitama, tejeduría en telar vertical en lana de oveja en Monguí y tejeduría en telar horizontal en Tópaga Boyacá.

116 hojas : ilustraciones, fotografía a color.

Asesoría en diseño para la Asociación de Artesanas de la Cordillera, municipio de Melgar, departamento del Tolima : informe final.

204 hojas : ilustraciones, fotografías a color.

Ilustraciones de fases del proceso de producción cerámico del Taller de Guatavita.

30 hojas : ilustraciones, fotografías a color

Muestras de productos con y sin esmaltado, elaborados en Guatavita.

19 hojas : ilustraciones, fotografías

Aspectos que fundamentan el análisis del discurso matemático escolar

Se presenta un análisis sobre los propósitos de la investigación del discurso matemático escolar, los tipos de discursos que se desarrollan en el aula, así como las contribuciones que ofrecen los estudios en este campo, particularmente, en la reconstrucción del discurso matemático escolar.

Construcción de la recta tangente variacional a traves de los usos del conocimiento del siglo XVII y XVIII

El presente trabajo es una investigación en curso. Una fuente de dificultades didácticas es la interpretación geométrica de la derivada, en donde la recta tangente no se considera como objeto de estudio. Nuestro planteamiento es que al construir la recta tangente desde una perspectiva variacional puede servir como una introducción a la derivada desde un punto de vista gráfico, lo cual implica también un rediseño del Discurso Matemático Escolar. Utilizamos la teoría de la Socioepistemología, en la cual se plantea que el uso de herramientas matemáticas para resolver actividades organizadas intencionalmente con la intención de resolver un problema, son una práctica, normadas por una práctica social. El escenario histórico nos ha servido para reconocer la práctica de la tangente variacional. Actualmente hemos implementado un método para obtener nuestros datos el cual nos servirá para que un futuro próximo podamos analizarlos y obtener conclusiones.

Desarrollo de la noción de graficación en la antigüedad

En este artículo se presenta un estudio socioepistemológico del desarrollo de la noción de graficación entendida como una actividad vinculada al estudio o tratamiento de las funciones. Aunque no fue sino hasta finales del siglo XIX cuando se define a la función tal y como la conocemos ahora, nuestro estudio en la época antigua en la que se evidencia el uso de las gráficas y se concluye la existencia de procedimientos, estrategias o ciertas técnicas que conduce a la graficación.