Criterios de Implementación ISO 14001 de 2015 Caso de Estudio Sector Floricultor

Mediante el análisis de un estudio de caso basado en la situación ambiental de la empresa Rosas Aguaclara SAS perteneciente al sector floricultor de Colombia, se diagnostica la posibilidad y aproximación de implementar, controlar y ejecutar el Sistema de Gestión Ambiental, basados en la aplicación de requisitos, formulación de preguntas y procesos de auditoría interna de acuerdo a lineamientos establecidos por la Norma ISO 14001:2015.Through the analysis of a case study based on the environmental situation of the company Rosas Aguaclara SAS belonging to the floricultural sector of Colombia, the possibility and approach of implementing, controlling and executing the Environmental Management System is diagnosed, based on the application of requirements , formulation of questions and internal audit processes according to guidelines established by ISO 14001: 2015

Diplomado de Profundización Acompañamiento Psicosocial en Escenarios de Violencia La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Departamento del Cauca.

Diplomado de Profundización Acompañamiento Psicosocial en Escenarios de Violencia La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Departamento del Cauca.En el presente informe se analiza y se trabaja los contenidos de las referencias estipuladas en el Diplomado de Profundización de Acompañamiento Psicosocial en Escenarios de Violencia, dentro de su contenido se presentan relatos de vida de familias enteras que han sufrido los flagelos de la violencia en diferentes territorios del país, los cuales han dejado un sin número de víctimas e innumerables heridas difíciles de sanar, pues ha cobrado vidas, desintegración de familias a causa del desplazamiento, discapacidades, secuestros, desapariciones entre otros casos de violencia, han dejado grandes secuelas físicas y psíquicas en las comunidades campesinas e indígenas. El relato de un joven de catorce años en el departamento de Nariño impacto con las heridas que la violencia trajo a él, a su familia y toda una comunidad, un acto violento acabo con gran parte de sus sueños; a partir del conocimiento de este relato principalmente se formularon interrogantes a aplicar a la víctima con el fin de identificar desde su propia subjetividad como vivió y sigue en pie de lucha por sus sueños personales y familiares, desde los enfoques psicosociales se pretende promover el restablecimiento de los derechos de las víctimas de la violencia en todo el territorio nacional, la identificación de su identidad y recuperación de su dignidad, que, mediante acciones estratégicas se logre restablecerlas garantizando la rehabilitación de los efectos negativos de la violencia. Teniendo en cuenta la magnitud de los relatos se puede identificar la afectación física y psicológica de muchas familias que han pasado por estas situaciones, es por ello lo importante de poder brindar un acompañamiento psicosocial a las comunidades afectadas, la caracterización con participación de los directamente afectados será posible identificar claramente cuáles han sido los daños e impactos a modo personal, familiar y social, a partir 4 de una postura clara y coherente desde la técnica Análisis del Relato en un escenario, siendo posible también la identificación de sus propias capacidades que les permita hacer uso de ellas para lograr restablecerse y dar continuidad con su vida y se conviertan en comunidades resilientes donde el apoyo, la comprensión y el esfuerzo mutuo sea base la sobreponerse de las adversidades.This report analyzes and works the contents of the references stipulated in the Diploma of Deepening of Psychosocial Accompaniment in Scenarios of Violence, within its content there are life stories of entire families who have suffered the scourges of violence in different territories of the country, which have left countless victims and innumerable wounds difficult to heal, as it has taken lives, family break-up due to displacement, disabilities, kidnappings, disappearances among other cases of violence, have left great physical consequences and psychic in rural and indigenous communities. The story of a fourteen-year-old in the department of Nariño impacted the injuries that violence brought to him, his family and an entire community, a violent act ended with much of his dreams; Based on the knowledge of this story, questions were mainly asked to apply to the victim in order to identify from his own subjectivity how he lived and continues to fight for his personal and family dreams, since psychosocial approaches are intended to promote the restoration of the rights of victims of violence throughout the national territory, the identification of their identity and recovery of their dignity, which, through strategic actions, can be restored by guaranteeing the rehabilitation of the negative effects of violence. Taking into account the magnitude of the stories, the physical and psychological involvement of many families who have been through these situations can be identified, which is why it is important to be able to provide psychosocial support to the affected communities, the characterization with participation of those directly affected It will be possible to clearly identify what the damages and impacts have been in a personal, family and social way, and it is also possible to identify their own capacities that allow them to use them to recover and continue with their lives and become resilient communities where support, understanding and mutual effort is based on overcoming adversity

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effets des polluants environnementaux in vitro sur le modèle neurodéveloppemental SH-SY5Y

Les polluants environnementaux sont présents dans le monde entier et constituent un groupe diversifié de substances chimiques principalement issues d'activités anthropiques. L'être humain y est quotidiennement exposé et, bien que des évaluations réglementaires soient effectuées pour limiter leurs effets, les effets d'expositions chroniques à de faibles doses et/ou combinées à plusieurs composés demeurent peu documentés. Le développement du système nerveux, particulièrement du cerveau, est hautement contrôlé et sensible à toute perturbation. En effet, des polluants tels que le plomb, le méthyl-mercure et le bisphénol A ont été associés à une diminution des fonctions cognitives et des troubles du comportement chez les enfants. Certains d'entre eux pourraient être liés à une altération du neurodéveloppement et ont été associés, parmi d'autres, à un groupe de pathologies du neurodéveloppement telles que le trouble du déficit de l'attention avec hyperactivité et les troubles du spectre autistique. Ces troubles ont généralement une étiologie complexe avec une interaction entre prédisposition génétique et facteurs environnementaux. Il est donc important de caractériser les mécanismes potentiels de neurotoxicité de ces composés pour évaluer leur rôle potentiel dans l'apparition de ces maladies. Ce travail a été réalisé dans le cadre du réseau européen « Neurosome » et visait à mieux comprendre les impacts neurotoxiques moléculaires et cellulaires de mélanges de polluants en utilisant un modèle in vitro basé sur la lignée cellulaire neuroblastique humaine SH-SY5Y, et à identifier des biomarqueurs d'altération du neurodéveloppement. Le traitement séquentiel de cellules SH-SY5Y avec de l'acide rétinoïque (pendant 5 jours) et le facteur neurotrophique BDNF (pendant 4 jours) transforme les cellules neuroblastiques en cellules matures de type neurone avec une morphologie caractéristique comprenant un corps cellulaire et des neurites connectés les uns aux autres. Les cellules ont été exposées, dès le début de la différenciation et pendant 9 jours, à un mélange de 8 polluants représentatifs de l'environnement comprenant des composés inorganiques (méthylmercure, plomb, manganèse) et organiques (benzène, trois phtalates, bisphénol A) identifiés par le réseau Neurosome. Trois versions (H. moyenne, H. max et H. 10x max) de ce mélange ont été utilisées, en fonction des concentrations de polluants choisies sur la base d'une modélisation mathématique des concentrations moyennes et maximales attendues dans le cerveau humain et 10 fois la concentration maximale. Les effets de métaux ioniques neurotoxiques connus (plomb, manganèse, cadmium) ont aussi été testés seuls et/ou en combinaison (plomb + manganèse) sur ce même modèle cellulaire. La cytotoxicité a été déterminée par le test MTS et la cytométrie a été utilisée pour évaluer la mort cellulaire (coloration à l'iodure de propidium) et l'apoptose (activités des caspases-3/7). Le mélange H. 10x max a déclenché la mort cellulaire apoptotique. Les effets des polluants sur l'expression des gènes ont été évalués par la technique à grande échelle de RNAseq, montrant des effets sur des fonctions cellulaires importantes dans les neurones telles que le métabolisme, la synaptogenèse et la fonction du réticulum endoplasmique. Des colorations immunocytochimiques ont été utilisées pour évaluer les effets des polluants sur la croissance des neurites (marquages NEFL et MAP2) et la formation des synapses (marquages SV2 et PSD95) et montrent que l'exposition au mélange H. max altère l'axonogenèse. Les résultats obtenus dans le cadre de ce projet indiquent que les neurotoxiques du développement peuvent agir à des doses inférieures à celles requises pour provoquer une cytotoxicité, mais pouvant entraîner des perturbations permanentes. Ces résultats sont d'autant plus significatifs que le mélange de polluants et les concentrations utilisées sont représentatifs de celles rencontrées dans l'environnement.Environmental pollutants are worldwide present and constitute a highly diverse group of chemicals, mostly derived from anthropogenic activities. Humans are daily exposed to various of these chemicals and, although regulatory assessments are conducted to avoid potential adverse effects, there is a lack of information regarding the effects of chronical exposure to low doses of these compounds and the effects of combined exposure to several compounds. The development of the nervous system, particularly the brain, is highly controlled and sensitive to any disruption. Indeed, several pollutants such as lead, methylmercury and bisphenol A have been linked to decreased cognitive function and behavioural difficulties in children. Some of them could be linked to impaired neurodevelopment and, some of these compounds and additional ones have been linked to the incidence of neurodevelopmental disorders, a group of diseases with onset during the developmental period comprising conditions such as attention deficit hyperactivity disorder and autistic spectrum disorders. These disorders usually have complex aetiology with interplay of genetic predisposition and environmental factors. It is thus important to characterise the potential mechanisms of neurotoxicity of these compounds to assess their potential role in the onset of these diseases. The present work was performed in the context of the Neurosome European network and was aimed to better understand the molecular and cellular neurotoxic impacts of mixtures of pollutants by using an in vitro model based on the SH-SY5Y human neuroblastic cell line, and potentially identify biomarkers of impaired neurodevelopment. Sequential treatment of SH-SY5Y cells with retinoic acid (during 5 days) and brain-derived neurotrophic factor (during 4 days) shifts the neuroblastic cells to mature neuron-like cells with characteristic morphology comprising a cell body and neurites connecting to each other. Cells were exposed, from the onset of differentiation and for 9 days, to a mixture of 8 environmentally representative pollutants comprising inorganic compounds (methylmercury, lead, manganese) and organic compounds (benzene, three phthalates, bisphenol A) identified by the Neurosome network. Three versions (H. mean, H. max and H. 10x max) of this mixture were used, depending on the concentrations of pollutants chosen on the basis of mathematical modelling of expected mean and maximal concentrations in human brain and 10 times the expected maximal concentration, respectively. Additionally, the effects of known neurotoxic metals (lead, manganese, cadmium) have been tested alone and/or in combination (lead + manganese) on this same cell model. Cytotoxicity was determined using MTS assay and cytometry was used to assess cell death (propidium iodide staining) and apoptosis (caspases-3/7 activities). The H. 10x max mixture triggered apoptotic cell death. The effects of exposure to pollutants on gene expression have been assessed through the large scale RNAseq technique, showing effects on important cell functions in neurons such as metabolism, synaptogenesis, and endoplasmic reticulum function. Immunocytochemistry staining was also used to assess the effects of pollutants on neurite outgrowth and synapses formation. Cells were stained against neuron-specific cytoskeleton markers (NEFL, MAP2), as well as synaptic markers (SV2, PSD95). The H. max mixture treatment triggered altered axonogenesis. The results obtained in this research project supports the concept that developmental neurotoxicants can act at lower doses than those required to cause cytotoxicity but that can lead to permanent changes and disruptions. These results are especially significant since the mixture of pollutants and the concentrations used are environmentally representative

The SH-SY5Y human neuroblastoma cell line, a relevant in vitro cell model for investigating neurotoxicology in human: focus on organic pollutants

International audienceInvestigation of the toxicity triggered by chemicals on the human brain has traditionally relied on approaches using rodent in vivo models and in vitro cell models including primary neuronal cultures and cell lines from rodents. The issues of species differences between humans and rodents, the animal ethical concerns and the time and cost required for neurotoxicity studies on in vivo animal models, do limit the use of animal-based models in neurotoxicology. In this context, human cell models appear relevant in elucidating cellular and molecular impacts of neurotoxicants and facilitating prioritization of in vivo testing.The SH-SY5Y human neuroblastoma cell line (ATCC® CRL-2266TM) is one of the most used cell lines in neurosciences, either undifferentiated or differentiated into neuron-like cells. This review presents the characteristics of the SH-SY5Y cell line and proposes the results of a systematic review of literature on the use of this in vitro cell model for neurotoxicity research by focusing on organic environmental pollutants including pesticides, 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD), flame retardants, PFASs, parabens, bisphenols, phthalates, and PAHs. Organic environmental pollutants are widely present in the environment and increasingly known to cause clinical neurotoxic effects during fetal & child development and adulthood. Their effects on cultured SH-SY5Y cells include autophagy, cell death (apoptosis, pyroptosis, necroptosis, or necrosis), increased oxidative stress, mitochondrial dysfunction, disruption of neurotransmitter homeostasis, and alteration of neuritic length. Finally, the inherent advantages and limitations of the SH-SY5Y cell model are discussed in the context of chemical testing