SOCIO-PSYCHOLOGICAL STUDY AMONG INJECTABLE DRUG USERS IN KATHMANDU VALLEY

On the background of ever increasing HIV transmission in our community through various routes, the psychosocial factors related with intravenous drug abuse has become necessary to be studied. Aim of the study was to assess the Socio-psychological factors that influence people to use drugs, especially to use Injectable drugs. We enrolled a sample of 393 Intravenous drug users, all male, in the Kathmandu Valley. Participants were administered a semi structured proforma to assess the psychosocial issues related with the drug intravenous drug abuse. Mean age of the sample was 27.76+ 4.86 years. Majority were single, unemployed, Hindu and by caste Newars, with education more than high school (SLC or more). The first psychoactive substance use by most of them was cannabis. The most frequently used psychoactive substance was injection Buprenorphine (Tidigesic), which was followed by mixture of various substances (opiates, benzodiazepines, antihistamines) and Diacetyl morphine (Brown sugar). Factors associated with the start of the drugs were for enjoyment, friend’s pressure and to alleviate mental tension. Many accepted Injectable drug use contributing to problems in mental, marital, social, economic and legal aspects of their life. Despite knowing the harms caused by the drugs majority persist on its use. A needle exchange programme has been viewed positively by many. Key words: buprenorphin, needle sharing, needle replacement, HIV transmission

Emergency department triage: an ethical analysis

<p>Abstract</p> <p>Background</p> <p>Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency.</p> <p>Discussion</p> <p>In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a <it>comprehensive </it>ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.</p> <p>Summary</p> <p>We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.</p