RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato.

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process.

RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato. Objetivo teóricometodológicas teórico metodológicas análise Métodos Tratase Trata se sistemática público Resultados científicos disso empírico Conclusão Esperase Espera

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process. Objective theoreticalmethodological methodological frameworks Methods essay nonsystematic non systematic way debate Results development addition Conclusion article

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.

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.

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.

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.

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 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.

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.

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 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.

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.

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.

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.

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.