1. Investigación

Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-todate information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.

Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.

Desde 1997 la CEU-UCH imparte un seminario anual sobre comunicación y discapacidad que, en 2005 se convirtió en una línea de investigación que ha desarrollado ya diversas aproximaciones al objeto de estudio, el tratamiento que los medios dan a la discapacidad, tanto en España como en la Comunidad Valenciana. Se trata de un objeto ya estudiado en España, pero de forma esporádica y discontinua. El objetivo de esta comunicación es presentar dicha línea de investigación, los estudios que ha llevado a cabo, así como las dificultades y los planteamientos metodológicos con los que la línea se ha encontrado. Hasta el momento, el grupo ha desarrollado tres investigaciones acerca del tratamiento de la discapacidad en los medios: una primera, de ámbito autonómico, en la que se estudiaron las referencias en prensa y en los informativos de televisión y radio de mediodía de una “semana tipo” construida con días alternos de semanas distintas; una segunda sobre el tratamiento que los medios españoles –prensa, radio y televisión– otorgaron a los pasados Juegos Paralímpicos de Pekín, que incluye elementos comparativos con el tratamiento de los Juegos Olímpicos (esta investigación está en su fase final); y una tercera, que acaba de iniciarse, que vuelve sobre el discurso de los medios valencianos –prensa, radio y televisión–, pero ahora con un planteamiento más exhaustivo y continuado: se analizarán las noticias publicadas en septiembre y octubre de 2009 y se aplicará un análisis de contenido y de discurso a las referencias, una vez constatados los datos a partir de una medición cuantitativa. La metodología aplicada a esta última aproximación se mejorará y aplicará a una nueva investigación a lo largo del presente año, a partir de una muestra de medios valencianos y eligiendo para ello uno de cada cuatro días entre enero y junio.

En la presente comunicación se analiza el tratamiento que los medios de comunicación impresos valencianos otorgan habitualmente a la discapacidad como objeto noticioso. La muestra recoge las noticias sobre esta cuestión publicadas en los cuatro diarios más leídos de la Comunitat Valenciana (El País, El Mundo, Levante-EMV y Las Provincias) entre el 1 de septiembre y el 31 de octubre de 2009 y entre el 1 de diciembre de 2009 y el 30 de abril de 2010. Después de realizar un estudio cuantitativo para determinar el volumen de lo publicado, así como sus características periodísticas fundamentales con el objetivo de determinar la importancia que los diarios dieron a este tipo de información, se aplica a cada pieza un análisis de contenido y de discurso. De la investigación se concluye el afianzamiento de algunas tendencias positivas que veníamos constatando en estudios anteriores como la presencia de la discapacidad en las páginas de los rotativos, no ya como asunto excepcional, sino como ítem noticioso transversal, es decir, unido a una enorme diversidad de cuestiones de actualidad, lo que potencia su visibilidad. Respecto del tratamiento informativo, se consolidan también tendencias positivas como no se recluir la discapacidad en espacios ad hoc ni en las páginas finales de los diarios; aumenta la referencia a las soluciones, al tiempo que aminora la de los problemas; desaparecen prácticamente las mediatizaciones venales, así como las apelaciones a la piedad y la conmiseración; y se nota un esfuerzo creciente por no dañar la identidad de las personas con discapacidad protagonistas de las informaciones. Finalmente, y por lo que hace al lenguaje, parece haberse afianzado el uso del término “persona con discapacidad” y todos sus derivados, al tiempo que se observa una mayor tendencia a la especificidad terminológica, que, sin ser todavía la suficiente, mejora respecto del pasado.