Años de vida perdidos y distribución espacial de la mortalidad por incidente vial en Medellín, 2010-2020

Objetivo: Estimar los años potenciales de vida perdidos y la distribución espacial de la mortalidad por incidente vial según modo de transporte en Medellín 2010-2020, como línea base para la implementación de la estrategia Visión Cero, de la Organización Mundial de la Salud, en la movilidad de la ciudad. Metodología: Estudio retrospectivo y descriptivo de corte transversal, con fuente secundaria. El cálculo de los años potenciales de vida perdidos se hizo tomando como edad límite la esperanza de vida al nacer de Colombia, según año y género. El análisis espacial se realizó a partir de la dirección del incidente; la representación de la densidad de Kernel fue por el método de clasificación estándar-cuantil, y las zonas de influencia se crearon por el método búfer de anillos múltiples, con distancias de 500 y 1000 metros. Resultados: Medellín, entre 2010 y 2020, registró 2988 muertes por incidente vial. Quienes más murieron fueron los peatones, con 1423 (47,6 %) muertes, seguidos por los motociclistas, con 1295 (43,3 %). Los años potenciales de vida perdidos fueron 98 787. Las comunas de mayor concentración en muerte de peatones fueron: Candelaria, Buenos Aires y Manrique; en motociclistas, la mayor concentración se evidenció en el sistema vial del río. Por zonas de influencia, los peatones fallecidos en un radio de 1000 metros del sistema vial del río fueron 688 (49,8 %), y los motociclistas, 636 (52,2 %). Conclusión: Los motociclistas fueron quienes murieron más jóvenes y más años dejaron de vivir. Politraumatismos son diagnósticos constantes de muerte, pero lesiones en cabeza, cráneo y tórax son más letales en peatones y motociclistas.

Objective: To estimate the potential years of life lost and the spatial distribution of mortality from road incidents by mode of transport in Medellín 2010-2020, as a baseline for the implementation of the Vision Zero strategy of the World Health Organization in the city's mobility. Methodology: This is a retrospective and descriptive cross-sectional study, with a secondary source. The calculation of the potential years of life lost was made using the life expectancy at birth in Colombia as the age limit, according to year and gender. The spatial analysis was carried out from the direction of the incident; Kernel density was represented by the standard-quantile classification method, and the zones of influence were created by the multiple ring buffer method, with distances of 500 and 1000 meters. Results: Between 2010 and 2020, Medellín registered 2,988 deaths due to road incidents. Those who died the most were pedestrians, with 1,423 (47.6%) deaths, followed by motorcyclists, with 1,295 (43.3%). Potential years of life lost were 98,787. The zones (comunas) with the highest concentration of pedestrian deaths were: Candelaria, Buenos Aires and Manrique; in motorcyclists, the highest concentration was evidenced in the river road system. By areas of influence, pedestrians killed within a radius of 1,000 meters from the river road system were 688 (49.8%), and motorcyclists, 636 (52.2%). Conclusion: Motorcyclists were the ones who died the youngest and the most years they stopped living. Polytrauma is a constant diagnosis of death, but injuries to the head, skull and thorax are more lethal in pedestrians and motorcyclists.

Objetivo: Estimar os anos potenciais de vida perdidos e a distribuição espacial da mortalidade por incidente de trânsito segundo o modo de transporte em Medellín 2010-2020, como linha base para a implementação da estratégia Visão Zero, da Organização Mundial da Saúde, na mobilidade da cidade. Metodologia: Estudo retrospectivo e descritivo de corte transversal, com fonte secundária. O cálculo dos anos potenciais de vida perdidos foi feito considerando como idade limite a esperança de vida ao nascer da Colômbia, segundo ano e gênero. A análise espacial realizou-se a partir do local do incidente; a representação da densidade de Kernel foi pelo método de classificação padrão-quantil, e as zonas de influência criaram-se pelo método buffer de anéis múltiplos, com distâncias de 500 e 1000 metros. Resultados: Medellín, entre 2010 e 2020, registrou 2988 mortes por incidente de trânsito. O maior número de mortes foi de pedestres, sendo 1423 (47,6%), seguido pelo de motoqueiros, sendo 1295 (43,3%). Os anos potenciais de vida perdidos foram 98.787. As localidades com maior concentração de mortes de pedestres foram: Candelaria, Buenos Aires e Manrique; no caso dos motoqueiros, a maior concentração evidenciou-se no sistema viário do rio. Por zonas de influência, os pedestres falecidos em um raio de 1000 metros do sistema viário do rio foram 688 (49,8%), e os motoqueiros 636 (52,2%). Conclusão: Os motoqueiros foram quem morreram mais novos e mais anos deixaram de viver. Politraumatismos são diagnósticos constantes de morte, mas lesões na cabeça, no crâneo e no tórax são mais letais em pedestres e motoqueiros.

Epidemiología y factores asociados en personas con discapacidad de origen vial en Medellín 2004-2017 / Epidemiology and associated factors in people with disabilities of road origin in Medellín 2004-2017

Resumen Objetivo: Caracterizar la epidemiología de la discapacidad de origen vial e identificar factores asociados a la dependencia funcional, participación en actos familiares, educativos y laborales en Medellín, Colombia 2004-2017. Métodos: Estudio longitudinal, con fuente de información secundaria, colectada con encuesta voluntaria y aplicada durante valoración clínica. Se analizó el total de registros de personas con discapacidad de origen vial y se desarrollaron cuatro modelos de regresión logística para identificar factores asociados con dependencia funcional, participación familiar, académica y laboral, con un error p = 0,05. Resultados: Entre 2004-2017, Medellín tenía registradas 63 848 personas con discapacidad. La causa que más la generó fue la enfermedad general con 21 444 (33,3%) registros. Los incidentes viales ocuparon el primer lugar entre eventos externos con 3092 (39,3%) casos: 2181 hombres (70,5%) y 911 mujeres (29,5%). Tener dos o más dificultades permanentes incrementó el riesgo de dependencia funcional (OR = 2,15; IC95%: 1,75-2,65). La no participación en actos familiares era reducida en personas con nivel académico superior (OR = 0,71; IC95%: 0,53-0,96). No participación en educación aumentó al no recibir ingresos (OR = 1,71; IC95%: 1,40-2,09). No participación laboral incrementó por barreras personales (OR = 1,61; IC95%: 1,10-2,34). Conclusión: La discapacidad de origen vial empuja familias en Medellín a mayor pobreza económica. La reintegración y participación en actos familiares y comunitarios de víctimas viales se restringe por factores físicos, ambientales y actitudinales.

Abstract Objective: To characterize the epidemiology of disability of road origin and to identify factors associated with functional dependence, participation in family, educational, and labor events in Medellin, Colombia 2004-2017. Methods: Longitudinal study, with a secondary information source for analysis of related factors. The information was collected via a voluntary survey, applied during clinical assessment to identify physical and psychological deficiencies and participation restrictions. The total records of people with disabilities of road origin were analyzed and four logistic regression models were developed to identify factors associated with functional dependence, family, academic and work participation, with an error P = 0.05. Results: Between 2004-2017 Medellin had registered 63,848 people with disabilities. The cause that most generated it was general disease with 21,444 (33.3%) records; road incidents ranked first among incidents with 3,092 (39.3%) cases. Men with disabilities of road origin were 2,181 (70.5%) and women 911 (29.5%). Having two or more permanent difficulties increased the risk of functional dependence (OR = 2.15; CI 95%: 1.75-2.65). Non-participation in family events was reduced in people with a higher academic level (OR = 0.71; CI 95%: 0.53-0.96). Non-participation in education increased due to not receiving economic income (OR = 1.71; CI95%: 1.40-2.09). Non-participation in work increased due to personal barriers (OR=1.61, CI95%: 1.10-2.34). Conclusion: Road origin disability pushes families in Medellin towards greater economic poverty. The reintegration and participation in family and community events of road victims is restricted by physical, environmental, and attitudinal.

Incidente vial relacionado con trabajo en transportadores de pasajeros y carga en Medellín Colombia: el rol de la infraestructura / Work-related crashes suffered by drivers in freight and passengers transportation activities Medellín Colombia: the road infrastructure role

RESUMEN Objetivo Analizar posibles relaciones entre infraestructura y ocurrencia de incidentes viales relacionados con el trabajo en transportadores de pasajeros y carga en Medellín entre el 2010 y el 2014. Métodos Estudio transversal de asociación entre infraestructura de incidentes viales durante el trabajo relacionados con lesiones de conductores, según la base de datos de informes policiales de accidentes de tránsito del 1.° de enero de 2010 al 31 de julio de 2014. Resultados Hubo 102 602 registros de incidentes viales relacionados con trabajo. El análisis multivariado fue posible con 8 516 registros con información completa entre marzo y julio de 2014. Los factores asociados al evento fueron: choque contra otro vehículo (RP 1,31 IC95 1,09-1,57); vías de dos carriles (RP 1,21 IC95 1,14-1,33) y de tres (RP 1,39 IC95 1,09-1,76); ser conductor de 18 a 24 años (RP 1,13 IC95 1,02-1,26); y conducir bajo efecto de alcohol (RP 2,81 IC95 2,42-3,26). Además, fueron identificados mediante análisis de información geográfica algunos puntos críticos de ocurrencia de incidentes viales relacionados con trabajo. Conclusiones Hay una tendencia creciente de incidentes viales relacionados con trabajo en Medellín. Se requiere especial atención al transporte de pasajeros y de carga por su representativo aporte al total de incidentes viales. El monitoreo de la infraestructura y de zonas de mayor incidencia puede ser útil en el diseño de programas de prevención en empresas de transporte.

ABSTRACT Objective To analyze associations between road infrastructure and Work-Related traffic accidents, in Medellin 2010-2014 in freight and passenger drivers. Methods A retrospective cross-sectional study to establish a possible association between road infrastructure and work-related traffic accidents with injuries for the driver in Medellín Colombia, using the Police traffic accident database, from January 2010 to July 2014. Results There were 102 602 records of traffic accidents. The multivariate analysis was conducted with 8516 records with complete information from March to July 2014. The factors associated with injury were: collision with another vehicle (PR 1,31 95CI 1,09-1,57); two-lane roads (PR: 1,21, 95% CI 1,14-1,33) and three-lane roads (PR: 1,39, 95CI 1,091,76); being a driver between 18 and 24 years old (PR 1.13 95 CI 1,02-1,26); and driving under the influence of alcohol (PR: 2,81 95% CI 2,42-3,26). In addition, through analysis of geographic information, critical points of work-related crashes were identified. Conclusion A growing trend of work-related traffic accidents was identified in Medellín. Special attention must be addressed to passenger and cargo transport due to its significant contribution to traffic accidents in the city. The monitoring of infrastructure and areas with the highest inci-dence can be useful in the design of prevention programs in transport companies.

Factors associated with exclusive breastfeeding practice in a cohort of women from Cali, Colombia.

INTRODUCTION: Breastfeeding promotion is one of the most effective strategies to prevent child malnutrition; it reduces costs to families, health services and society. In Colombia, exclusive breastfeeding is practiced only by 10% of women. OBJECTIVE: To identify factors associated with the duration of exclusive breastfeeding. METHODS: A cohort of 438 primiparous women was followed during 6 months by means of 8 home interviews, in order to determine the duration of exclusive breastfeeding. Individual, family and health service factors were studied; and survival analysis was carried out. RESULTS: At 8 days, only a few more than half of the participants maintained exclusive breastfeeding; at month 6 of follow-up, this proportion was reduced to 1.4%. The duration of exclusive breastfeeding was determined by: initiation of breastfeeding in the first 4 hours after delivery (HR= 4.07, 95% CI: 0.96-16.67), self-perceived sureness for breastfeeding (HR= 1.28, 95% CI: 1.04 -1.58), positive opinion of the baby's father regarding breastfeeding (HR= 1.26, 95% CI: 1.01-1.57), and newborn weight (HR= 1.23, 95% CI: 1.00-1.53). CONCLUSION: There are factors before delivery and in the immediate puerperium that determine, partially, the duration of exclusive breastfeeding.

INTRODUCCIÓN: La promoción de la lactancia es una de las estrategias más efectivas para evitar la desnutrición infantil; reduce costos a las familias, los servicios de salud y la sociedad. En Colombia solo 10% de las mujeres practican la lactancia materna exclusiva. OBJETIVO: Identificar factores asociados a la duración de la lactancia exclusiva. MÉTODOS: Se siguió durante 6 meses a una cohorte de 438 mujeres primíparas mediante 8 entrevistas domiciliarias para determinar la duración de lactancia exclusiva. Se estudiaron factores individuales, familiares y de servicios de salud y se realizó análisis de sobrevida. RESULTADOS: A los 8 días sólo un poco más de la mitad de participantes mantenía lactancia exclusiva; al mes 6 de seguimiento esta proporción se redujo a 1.4%. La duración de lactancia exclusiva estuvo determinada por: inicio de lactancia en las primeras 4 horas pos-parto (HR= 4.07; IC 95%: 0.96-16.67), seguridad auto-percibida para amamantar (HR= 1.28; IC 95%: 1.04-1.58), opinión positiva del padre del bebé frente a lactancia (HR= 1.26; IC 95%: 1.01-1.57) y peso de recién nacido (HR= 1.23; IC 95%: 1.00-1.53). CONCLUSIÓN: Existen factores antes del parto y en el puerperio inmediato que determinan, parcialmente, la duración de la lactancia exclusiva.

Factors associated with exclusive breastfeeding practice in a cohort of women from Cali, Colombia / Factores asociados con la práctica de lactancia exclusiva en una cohorte de mujeres de Cali, Colombia

Abstract Introduction: Breastfeeding promotion is one of the most effective strategies to prevent child malnutrition; it reduces costs to families, health services and society. In Colombia, exclusive breastfeeding is practiced only by 10% of women. Objective: To identify factors associated with the duration of exclusive breastfeeding. Methods: A cohort of 438 primiparous women was followed during 6 months by means of 8 home interviews, in order to determine the duration of exclusive breastfeeding. Individual, family and health service factors were studied; and survival analysis was carried out. Results: At 8 days, only a few more than half of the participants maintained exclusive breastfeeding; at month 6 of follow-up, this proportion was reduced to 1.4%. The duration of exclusive breastfeeding was determined by: initiation of breastfeeding in the first 4 hours after delivery (HR= 4.07, 95% CI: 0.96-16.67), self-perceived sureness for breastfeeding (HR= 1.28, 95% CI: 1.04 -1.58), positive opinion of the baby's father regarding breastfeeding (HR= 1.26, 95% CI: 1.01-1.57), and newborn weight (HR= 1.23, 95% CI: 1.00-1.53). Conclusion: There are factors before delivery and in the immediate puerperium that determine, partially, the duration of exclusive breastfeeding.

Resumen Introducción: La promoción de la lactancia es una de las estrategias más efectivas para evitar la desnutrición infantil; reduce costos a las familias, los servicios de salud y la sociedad. En Colombia solo 10% de las mujeres practican la lactancia materna exclusiva. Objetivo: Identificar factores asociados a la duración de la lactancia exclusiva. Métodos: Se siguió durante 6 meses a una cohorte de 438 mujeres primíparas mediante 8 entrevistas domiciliarias para determinar la duración de lactancia exclusiva. Se estudiaron factores individuales, familiares y de servicios de salud y se realizó análisis de sobrevida. Resultados: A los 8 días sólo un poco más de la mitad de participantes mantenía lactancia exclusiva; al mes 6 de seguimiento esta proporción se redujo a 1.4%. La duración de lactancia exclusiva estuvo determinada por: inicio de lactancia en las primeras 4 horas pos-parto (HR= 4.07; IC 95%: 0.96-16.67), seguridad auto-percibida para amamantar (HR= 1.28; IC 95%: 1.04-1.58), opinión positiva del padre del bebé frente a lactancia (HR= 1.26; IC 95%: 1.01-1.57) y peso de recién nacido (HR= 1.23; IC 95%: 1.00-1.53). Conclusión: Existen factores antes del parto y en el puerperio inmediato que determinan, parcialmente, la duración de la lactancia exclusiva.

Epidemiología de incidentes viales en Medellín-Colombia, 2010-2015 / Road traffic incidents epidemiology in Medellin-Colombia, 2010-2015 / Epidemiologia de incidentes rodoviários de Medellín-Colômbia, 2010-2015

Resumen Incidentes Viales (IV) trasfieren energía cinética entre superficies inertes y vivas en corredores de movilidad. Causan lesiones fatales y no fatales, con efectos en salud, bienestar y productividad. No dependen del azar o suerte y no son accidentes como Naciones Unidas señaló hace décadas. Objetivo: Describir la epidemiología de IV en Medellín 2010-2015, como referente para proponer un Modelo de Gestión en Seguridad Vial - el MOGESVI. Metodología: Retrospectiva, con diversas fuentes sobre IV y análisis uni o bivariado. Resultados: Desde 2010 hay registro creciente, acumulando 275.000 IV a 2015, con media de 45.000/año y 135/día; lo no registrado podría ser 4 veces más. Hubo lesiones en 50% de los IV registrados en Informe Policial de Accidente de tránsito (IPAT), con media de 300 muertos/año y unos 3.000 heridos/año; lesionados no registrados pueden ser 10 veces más, 30.000/año. La mayoría de IV afecta pobres, peatones, moteros y ciclistas, principalmente varones de 15-29 años, en zonas residenciales. Conclusiones: Liderazgo, Política Pública, Observatorio en Seguridad Vial y Gestión del Plan de Movilidad Segura a 2020 son críticos para reducir riesgo, exposición y frecuencia de IV.

Abstract Road incident-RI is an event that transferred kinetic energy between surfaces in a mobility corridor. Such transfer cause fatal or no fatal injuries to people walking, bike, or motorized vehicles. Are not dependent of chance or luck and are not accidental, as the United Nations pointed four decades ago. Objective: To describe the epidemiology of RI in Medellin from 2010 to 2015, as a reference to use a Management Model of Road Safety. Methodology: Empirical-analytic study, cross-sectional retrospective, and descriptive communication of secondary source information. Results:From 2010 there was increased register of RI to 275.000, 45.000/year or 135/day; unregistered data are more. According severity, injuries resulted in 50% of RI, for average of 300 deaths/year and wounded assessed by forensic from 3.000/year that could be 30.000, almost all vulnerable road users: pedestrians, motorcyclists and cyclists, men 15-29 years in residential areas. Conclusions: Serious limitations for an effective management and coordinated response were found due to the underreporting, weak data management and the absence of: Public Policy, Road Safety Observatory and Information System. Are dimensions are critical to reduce risk, exposure and frequency of RI in Medellín.

Resumo Os Incidentes em Vias (IV) transferem energia cinética entre superfícies inertes e vivas em corredores de mobilidade. Causam lesões fatais e não fatais, afetando a saúde, o bem-estar e a produtividade. Não dependem da sorte ou do azar e não são acidentes, como as Nação Unidas sublinhou faz décadas. Objetivo: Descrever a epidemiologia dos IV em Medellín 2010-2015, como referente para propor um Modelo de Gestão em Segurança em Vias - o MOGESVI. Metodologia: Retrospectiva, com diversas fontes sobre IV e análises univariada ou bivariada. Resultados O registro aumenta desde 2010, acumulando 275.000 IV até 2015, com média de 45.000/ano e 135/dia. A quantidade não registrada poderia ser 4 vezes maior. Houve lesões em 50% dos IV registrados no Relatório Policial de Acidentes de Trânsito (IPAT), com média de 300 mortos/ano e uns 3.000 feridos/ano. As lesões não registradas poderiam ser até 10 vezes mais: 30.000/ano. A maioria dos IV afeta aos pobres, aos pedestres, aos motoqueiros e ciclistas, principalmente do sexo masculino entre 15-29 anos, nas áreas residenciais. Conclusões: Para reduzir o risco, a exposição e a frequência aos IV, a Liderança, as Políticas Públicas, o Observatório em Segurança de Vias e a Gestão do Plano de Mobilidade Segura a 2020 são de muita importância.

Movilidad: Aporte para su discusión / Mobility: contribution for discussion

La movilidad es el mayor desafío de la civilización humana. OBJETIVO: aportar a la discusión conceptual del asunto en dos de sus dimensiones básicas: segura y sostenible. METODOLOGIA: se revisó literatura en español, inglés y portugués sobre los términos movilidad, mobility y movilidade en su relación a la seguridad vial en el transporte sostenible, a partir del año 2010 en formato de libro, reporte y artículo científico; se identificaron veinticinco textos a partir de los cuales se hizo síntesis argumentativa. RESULTADOS : moverse con seguridad y sostenibilidad tiene implicaciones en la salud física y mental de personas y poblaciones; es un derecho ciudadano, precepto constitucional y deber del Estado, determinante de bienestar y desarrollo con definidos antecedentes históricos y paradigmáticos relacionados a la sostenibilidad ambiental, económica y social amenazada por la ocupación del suelo, la concentración de personas y la motorización de la vida.

Mobility is the greatest challenge of human civilization. OBJECTIVE: to contribute to the conceptual discussion of the topic in two of its basic dimensions: safe and sustainable. Methodology: literature was reviewed in Spanish, English and Portuguese on the terms mobilidad, mobility and movilidade in relation to road safety in sustainable transport, starting from the year 2010 in book, report and scientific paper format; Twenty five texts were identified and argumentative synthesis of all of them was made. RESULTS : to move safely and with sustainability has implications in the physical and mental health of individuals and populations; It is a citizen right, constitutional obligation and duty of the State, determinant of welfare and development with defined paradigmatic and historical records related to the environmental, economic and social sustainability, threatened by the occupation of the soil, the concentration of people and the motorization of life.

[The decade of action for road safety in Medellin, Colombia, to 2015]. / La década de acción en seguridad vial en Medellín, Colombia, a 2015.

Road safety (RS) is key in the study and intervention of human mobility. It is a determining priority in international public health and in the development of communities and nations. The declaration of a global RS crisis in the 1990s by the United Nations urged the social, political and technical processes to propose the Decade of Action for Road Safety 2010-2020 (DARS). The DARS has a global action plan structured around five pillars; the first refers to institutional management. The article describes the background, framework, evidence, and effects of poor management during first half of the DARS in Medellin, Colombia up to 2015.

La década de acción en seguridad vial en Medellín, Colombia, a 2015 / The decade of action for road safety in Medellin, Colombia, to 2015

La seguridad vial-SV es dimensión clave del estudio e intervención de la movilidad humana. Es hace décadas prioridad en salud pública internacional y determinante del desarrollo de comunidades y naciones. La declaratoria de una crisis global de SV en los años 90 del siglo XX por las Naciones Unidas impulsó los procesos sociales, políticos y técnicos para proponer la Década de Acción en Seguridad Vial-DASV 2010-2020. La DASV tiene un plan de acción global estructurado en cinco pilares, el primero referido a la gestión institucional de la SV. Este artículo describe antecedentes, marcos, evidencias y los pobres efectos de la gestión del primer quinquenio de la DASV en Medellín, Colombia, al año 2015.

Road safety (RS) is key in the study and intervention of human mobility. It is a determining priority in international public health and in the development of communities and nations. The declaration of a global RS crisis in the 1990s by the United Nations urged the social, political and technical processes to propose the Decade of Action for Road Safety 2010-2020 (DARS). The DARS has a global action plan structured around five pillars; the first refers to institutional management. The article describes the background, framework, evidence, and effects of poor management during first half of the DARS in Medellin, Colombia up to 2015.

[Household costs of maintaining and/or abandoning exclusive breastfeeding during the first postpartum month]. / Costos Familiares de Mantener y Abandonar la Lactancia Exclusiva en el Primer Mes Posparto.

OBJECTIVE: Estimating the difference between direct and indirect family costs arising from women who continue exclusive breastfeeding and those who abandon it during the first postpartum month. METHODS: A cost analysis was carried out on primiparous women from Cali, Colombia; they were recruited during their immediate puerpery and follow-up during the first 30 postpartum days. Non-parametric Bootstrap techniques were used for estimating average costs and differences for 0-8, 9-30 and 0-30 postpartum days regarding women who abandoned exclusive breastfeeding and those who did not. RESULTS: Women who abandoned exclusive breastfeeding assumed higher costs related to baby feeding while those who continued exclusive breastfeeding had higher food costs for the mother and in contracting domestic support. CONCLUSION: The savings which a woman and her family can make due to continuing with exclusive breastfeeding become negated by the mother's food-related costs. Interventions should be designed which are orientated towards prolonging exclusive breastfeeding and modifying beliefs about nutrition which contribute towards generating economic consequences for families.

Costos Familiares de Mantener y Abandonar la Lactancia Exclusiva en el Primer Mes Posparto / Household costs of maintaining and/or abandoning exclusive breastfeeding during the first postpartum month

Objetivo Estimar la diferencia de costos familiares, directos e indirectos, generados entre mujeres que mantienen la lactancia exclusiva y aquellas que la abandonan, durante el primer mes posparto. Métodos Se realizó un análisis de costos en primíparas de Cali, captadas en su puerperio inmediato y seguidas durante los primeros 30 días posparto. Mediante técnicas no-paramétricas Bootstrap, se estimaron los costos y las diferencias promedio, para los 0-8, 9-30 y 0-30 días posparto, entre mujeres que abandonaron la lactancia exclusiva y aquellas que no abandonaron. Resultados Las mujeres que abandonaron la lactancia exclusiva asumieron mayores costos en alimentación del recién nacido, mientras que aquellas que la mantuvieron tuvieron mayores costos en alimentación para la madre y en contratación de apoyo doméstico. Conclusión Los ahorros que una mujer y su familia pueden tener al mantener la lactancia exclusiva son superados por los costos que se generan en alimentación para la madre. Es necesario diseñar intervenciones orientadas a incrementar la duración de la lactancia exclusiva y a modificar creencias nutricionales que contribuyen a generar consecuencias económicas sobre las familias.

Objective Estimating the difference between direct and indirect family costs arising from women who continue exclusive breastfeeding and those who abandon it during the first postpartum month. Methods A cost analysis was carried out on primiparous women from Cali, Colombia; they were recruited during their immediate puerpery and follow-up during the first 30 postpartum days. Non-parametric Bootstrap techniques were used for estimating average costs and differences for 0-8, 9-30 and 0-30 postpartum days regarding women who abandoned exclusive breastfeeding and those who did not. Results Women who abandoned exclusive breastfeeding assumed higher costs related to baby feeding while those who continued exclusive breastfeeding had higher food costs for the mother and in contracting domestic support. Conclusion The savings which a woman and her family can make due to continuing with exclusive breastfeeding become negated by the mother's food-related costs. Interventions should be designed which are orientated towards prolonging exclusive breastfeeding and modifying beliefs about nutrition which contribute towards generating economic consequences for families.

[Validating an instrument for measuring the perceived quality of services received by people using hospitals in Colombia]. / Validación de un Instrumento para Medir Calidad Percibida por Usuarios de Hospitales de Colombia.

OBJECTIVE: Validating an instrument for measuring the perceived quality of services received by people using hospitals forming part of the Colombian Ministry of Social Protection's restructuring, redesigning and modernisation programme for health-service providing networks. METHODS: Sánchez and Echeverri's guidelines for validating health quality measurement scales were followed due to the lack of a valid instrument for doing this in Colombia. RESULTS: Conceptual synthesis led to identifying a structure of constituent indicators, domains and sub-domains regarding the perception of health service quality. A list of reactions (having a scale for categorising the replies) was analysed according to the validity of appearance, construct, criteria and utility as criteria for sensitivity and usefulness. Successive revisions and three rounds of field-trials led to producing PECASUSS, an acronym given to the instrument for measuring users' perception of health service quality (Percepción de Calidad Según Usuarios de Servicios de Salud). CONCLUSIONS: The guidelines effectively orientated the validation of the instrument required for measuring the perceived quality of health services received by people using hospitals forming part of the programme.

Calidad percibida por usuarios de hospitales del programa de reestructuración de redes de servicios de salud de Colombia / Quality as perceived by people using hospitals in the Colombian health service network restructuring programme

Objetivo Establecer una línea base de la calidad percibida por usuarios de hospitales objeto de intervención del Programa de reestructuración, rediseño y modernización de redes prestadoras de servicios de salud de Colombia. Método Con instrumento validado para medir Percepción de Calidad Según Usuarios de Servicios de Salud, el PECASUSS, en agosto de 2006 se entrevistaron cara a cara 4 021 usuarios de una muestra de los hospitales del Programa. Resultados Los entrevistados, con media de 38 años, 70 por ciento mujeres, 60 por ciento con afiliación al régimen subsidiado, 55 por ciento de estrato uno y 53 por ciento atendidos en consulta general, valoraron mayoritariamente como bueno o muy bueno el nivel de dieciséis aspectos perceptibles de la calidad de los servicios. En una escala de 0,0 (pésimo) a 5,0 (excelente), calificaron la calidad con una media de 3,98 (DE: 0,8). Conclusiones La calidad percibida por usuarios de los hospitales del Programa fue buena en general. El trato humanizado recibido de los funcionarios asistenciales fue la sub-dimensión de la calidad de la atención mejor valorada por los informantes.

Objective Establishing a quality base-line as perceived by hospital users, subject to intervention by the health-service restructuring, redesign and modernisation programme. Method 4 021 users were interviewed face-to-face in August 2006 from a sample of hospitals from the programme using an instrument already validated for measuring health service users’ perception of quality (PECASUSS). Results The interviewees (38,7 percent mean age, 70 percent women, 60 percent affiliated to the subsided system, 55 percent from stratum 1 and 53 percent attended in general consultation) scored mostly as good or very good 16 different aspects perceived of the quality of services. Mean user quality score was 3,98 (0,8 SD) on a score ranging from 0,0 (bad) to 5,0 (excellent). Conclusions Quality was generally rated as good as perceived by people using the hospital programme. The humanised treatment received from the medical staff was given the highest score regarding quality of attention received by the interviewees.

Validación de un instrumento para medir calidad percibida por usuarios de hospitales de Colombia / Validating an instrument for measuring the perceived quality of services received by people using hospitals in Colombia

Objetivo Validar un instrumento para medir calidad percibida por usuarios de hospitales del Programa de reestructuración, rediseño y modernización de redes prestadoras de servicios de salud del Ministerio de la Protección Social de Colombia. Método Ante la inexistencia en Colombia de instrumento válido, se siguieron los lineamientos de Sánchez y Echeverri para validar escalas de medición en salud. Resultados Según síntesis conceptual se identificó una estructura de indicadores, dominios y subdominios constituyentes de la percepción de calidad de servicios de salud. Se desarrolló un listado de reactivos con escala de categorización de respuestas que se analizaron según validez de apariencia, constructo, criterio y utilidad así como criterios de sensibilidad y practicidad. Revisiones sucesivas y tres rondas de prueba en campo generaron el PECASUSS, acrónimo dado al instrumento por Percepción de Calidad Según Usuarios de Servicios de Salud. Conclusiones Los lineamientos orientaron eficazmente la validación del instrumento requerido para medir calidad percibida por usuarios de hospitales del Programa.

Objective Validating an instrument for measuring the perceived quality of services received by people using hospitals forming part of the Colombian Ministry of Social Protection's restructuring, redesigning and modernisation programme for health-service providing networks. Methods Sánchez and Echeverri's guidelines for validating health quality measurement scales were followed due to the lack of a valid instrument for doing this in Colombia. Results Conceptual synthesis led to identifying a structure of constituent indicators, domains and sub-domains regarding the perception of health service quality. A list of reactions (having a scale for categorising the replies) was analysed according to the validity of appearance, construct, criteria and utility as criteria for sensitivity and usefulness. Successive revisions and three rounds of field-trials led to producing PECASUSS, an acronym given to the instrument for measuring users' perception of health service quality (Percepción de Calidad Según Usuarios de Servicios de Salud). Conclusions The guidelines effectively orientated the validation of the instrument required for measuring the perceived quality of health services received by people using hospitals forming part of the programme.

[Quality as perceived by people using hospitals in the Colombian health service network restructuring programme]. / Calidad percibida por usuarios de hospitales del programa de reestructuración de redes de servicios de salud de Colombia.

OBJECTIVE: Establishing a quality base-line as perceived by hospital users, subject to intervention by the health-service restructuring, redesign and modernisation programme. METHOD: 4 021 users were interviewed face-to-face in August 2006 from a sample of hospitals from the programme using an instrument already validated for measuring health service users' perception of quality (PECASUSS). RESULTS: The interviewees (38,7 % mean age, 70 % women, 60 % affiliated to the subsided system, 55 % from stratum 1 and 53 % attended in general consultation) scored mostly as good or very good 16 different aspects perceived of the quality of services. Mean user quality score was 3,98 (0,8 SD) on a score ranging from 0,0 (bad) to 5,0 (excellent). CONCLUSIONS: Quality was generally rated as good as perceived by people using the hospital programme. The humanised treatment received from the medical staff was given the highest score regarding quality of attention received by the interviewees.

[Use of theories and models on papers of a Latin-American journal in public health, 2000 to 2004]. / Uso de teorías y modelos en artículos de una revista latinoamericana de salud pública, 2000-2004.

OBJECTIVE: To characterize frequency and type of use of theories or models on papers of a Latin-American journal in public health between 2000 and 2004. METHODS: The Revista de Saúde Pública was chosen because of its history of periodic publication without interruption and current impact on the scientific communication of the area. A standard procedure was applied for reading and classifying articles in an arbitrary typology of four levels, according to the depth of the use of models or theoretical references to describe problems or issues, to formulate methods and to discuss results. RESULTS: Of 482 articles included, 421 (87%) were research studies, 42 (9%) reviews or special contributions and 19 (4%) opinion texts or assays . Of 421 research studies, 286 (68%) had a quantitative focus, 110 (26%) qualitative and 25 (6%) mixed. Reference to theories or models is uncommon, only 90 (19%) articles mentioned a theory or model. According to the depth of the use, 29 (6%) were classified as type I, 9 (2%) as type II, 6 (1.3%) were type III and the 46 remaining texts (9.5%) were type IV. CONCLUSIONS: Reference to models was nine-fold more frequent than the use of theoretical references. The ideal use, type IV, occurred in one of every ten articles studied. It is of relevance to show theoretical and models frames used when approaching topics, formulating hypothesis, designing methods and discussing findings in papers.

Uso de teorías y modelos en artículos de una revista latinoamericana de salud pública, 2000-2004 / Use of theories and models on papers of a Latin-American journal in public health, 2000 to 2004

OBJETIVO: Caracterizar la frecuencia y tipo de uso de teorías o modelos citados en artículos publicados en una revista latinoamericana de salud publica entre los años 2000 y 2004. MÉTODOS: Se escogió la Revista de Saúde Pública por su historia de publicación periódica sin interrupción e impacto actual en la comunicación científica del área. Se aplicó un procedimiento estándar para leer los artículos y clasificarlos en una tipología arbitraria de cuatro niveles según la profundidad del uso dado a los referentes teóricos o modelos citados en los textos para describir asuntos o problemas abordados, formular métodos y discutir a rigor los hallazgos comunicados. RESULTADOS: Se leyeron 482 artículos: 421 (87 por ciento) investigaciones, 42 (9 por ciento) revisiones o especiales y 19 (4 por ciento) textos de opinión o reflexión. En las 421 investigaciones, 286 (68 por ciento) tuvieron enfoque cuantitativo, 110 (26 por ciento) cualitativo y 25 (6 por ciento) mixtos. La cita de teorías o modelos fue infrecuente; 90 (19 por ciento) artículos revisados citan algun referente. Según la profundidad de uso 29 (6 por ciento) de los 90 fueron tipo I, 9 (1,9 por ciento) tipo II, 6 (1,3 por ciento) tipo III y 46 (9,5 por ciento), tipo IV. CONCLUSIONES: La citación de modelos fue nueve veces más frecuente que la de alguna teoría; el uso ideal, el tipo IV, ocurrió en apenas uno de cada diez artículos analizados. Hay relevancia de explicitar los marcos teóricos y modelos usados al abordar temas, formular hipótesis, diseñar métodos y discutir hallazgos en las contribuciones de las revistas científicas del área.

OBJECTIVE: To characterize frequency and type of use of theories or models on papers of a Latin-American journal in public health between 2000 and 2004. METHODS: The Revista de Saúde Pública was chosen because of its history of periodic publication without interruption and current impact on the scientific communication of the area. A standard procedure was applied for reading and classifying articles in an arbitrary typology of four levels, according to the depth of the use of models or theoretical references to describe problems or issues, to formulate methods and to discuss results. RESULTS: Of 482 articles included, 421 (87 percent) were research studies, 42 (9 percent) reviews or special contributions and 19 (4 percent) opinion texts or assays . Of 421 research studies, 286 (68 percent) had a quantitative focus, 110 (26 percent) qualitative and 25 (6 percent) mixed. Reference to theories or models is uncommon, only 90 (19 percent) articles mentioned a theory or model. According to the depth of the use, 29 (6 percent) were classified as type I, 9 (2 percent) as type II, 6 (1.3 percent) were type III and the 46 remaining texts (9.5 percent) were type IV. CONCLUSIONS: Reference to models was nine-fold more frequent than the use of theoretical references. The ideal use, type IV, occurred in one of every ten articles studied. It is of relevance to show theoretical and models frames used when approaching topics, formulating hypothesis, designing methods and discussing findings in papers.

[Emotional burn-out in official teachers, Medellin, Colombia, 2005]. / Desgaste emocional en docentes oficiales de Medellin, Colombia, 2005.

OBJECTIVE: Exploring signs of emotional and physical weakness or Burnout syndrome in qualified teachers in Medellin, Colombia, 2005. METHODS: A cross-sectional study was applied to a random bi-stage sample of 239 teachers who filled in a questionnaire by themselves to explore demographic, work and social variables and dimensions of the Burnout syndrome, according to the Maslach Burnout Inventary (MBI). RESULTS: The findings showed that 23.4% of the sample presented signs of Burnout and a further 23.4% were at risk of suffering it; emotional weakness and depersonalisation were present in both subgroups. CONCLUSIONS: A relationship between Burnout signs and some of the variables studied was found. It is suggested that personal, family and social variables potentially associated with the syndrome should be explored more deeply.