Over ninety percent of Traffic Accidents are caused by human error

The Sri Lanka Medical Association Road Traffic Accident Prevention Committee in a report to the Parliament Select Committee inquiring into the alarming increase in road traffic accidents in the country has stated that over 90 percent of these accidents are caused by human error, and only 10 per cent or less by mechanical failure or adverse road conditions.

In the report handed over to the Parliament Select Committee by the chairperson of the SLMA Road Traffic Accident Prevention Committee Prof. A.H. Sheriffdeen it is stated.

“Human error is mainly caused by speeding, overtaking without adequate vision, breaking of traffic rules like ignoring traffic lights and signs either deliberately or through ignorance, fatigue sleep while driving, distractions like cellular telephones and medical problems in the driver and driving after taking alcohol or drugs”.

No effective authority to supervise

The SLMA report further states: A National Conference on the Reduction of Road Traffic Accidents and injuries, was organised and held at the Contental hotel in collaboration with the Ministry of Healthcare and Nutrition in October 2005 chaired by H.E. the President.

There was participation from all Ministries concerned and several recommendations made but there was no active authority to supervise its implementation.

We believe strongly that a holistic view of the entire problem and its contributory factors should be addressed rather than looking at piecemeal solutions to individual situations.

The report adds

Injuries and deaths to persons involved in traffic accidents are mostly preventable and could be minimized. Seat belts wore by drivers and passengers of covered vehicles, helmets for users of motor cycles and mopeds and even bicycles on main roads, adequate lights and reflectors in bicycles, education in use of pedestrian crossings and correct location of such crossings lower the injury rate and severity of such persons.

The report continues:- “All the above mentioned facts are well known and many organizations and committees have made recommendations for action but there being no central authority that has the power to see that remedial measures are implemented, because many Ministries and Departments are involved the entire process gets delayed or worse still forgotten.

“The Ministries involved are Internal Security (police), Transport Highways and Road Development, Finance, Justice, Local Government, Healthcare, Education Media and Information, and Telecom.

“Our key recommendation is that a unified strategy be adopted to get concerted and speedy action in the following areas:

1. Ministry of Justice

Speedy legislation for the following: Compulsory use of Seat Belts Registration of Mopeds and thus compelling users to have a licence, a driving licence and to wear helmets Establishment of traffic Courts in each district if possible for speedy disposal of traffic offence cases.

2. Ministry of Transport

Implementation of the Demerit Point Scheme for Major and minor traffic offences, Computerization of the facilities at office of the Registrar of Motor Vehicles and Police and Traffic Courts and networking of these Departments, Regular renewal of Driving Licences Certification of roadworthiness of old Vehicles, Licensing of Driving Schools and supervision/implementation of curriculum, Education of Heavy vehicle Drivers on Fatigue, Micro sleep, sleep apnoea and road rage

3. Police

Recruitment of more Traffic with special training and certification, More roadworthy vehicles to the Traffic Police Department, More incentives to traffic Police for effective reduction of accidents compared to the previous years

4. Highways and Road Development

Maintenance of Roads especially pavements and skirting to protect road edges Accidents have been reported in the North Central Province as steep edges cause, loss of control of vehicles and damage to tires. Display of Speed Limit Signs. This is reaching alarming proportions. Most drivers are psychologically conditioned to slow down when they see a speed limit sign.

5. Local Government

Licensing and maintenance of bicycles Education of pedestrians and bicycle users Maintenance of pavements, control of hawkers, but stops and vehicle parking

6. Ministry of Healthcare and Nutrition

Establishment of trauma care facilities and training programs for all categories of staff, Effective Ambulance service with trained personnel in Primary care of the Injure-liaise with local authority Establishment of Disaster Management plan, Health Education Programmes for Drivers who suffer from chronic illnesses like Diabetes, Hypertension, Heart Disease, Vision problems, Hearing Disorders, Neurological\cal problems like stroke, epilepsy, amputations, deformities and neuro-muscular diseases etc.

7. Education

Inclusion of Highway Code in curriculum, regular training sessions on road use and use of vehicles like bicycles and mopeds

8. Ministry of Finance

Make budgetary allocations for speedy implementation of above projects

Information and Media

Education on Road Safety,

Highway Code

SLMA Road Traffic Accident Prevention Committee

The following comprise the above committee which includes Edward Arambewala from the Daily News representing the media.

Chairperson Prof A.H. Sheriffdeen

Convenor/Secretary Dr. D.M.S. Handagala

Members

Dr. Waruna Gunatilake

Prof Ravindra Fernando

Dr. Asitha Koshala

Ms Fathima Razik Cader

Mr. Lucky Peiris

Anil Jayasinghe

Prof Mandika Wijeyaratne

Dr. Sujatha Samarakoon

Dr. Lakshmi Somatunge

Mr. Edward Arambewela

Dr. Y.I.K. Abeywickrema

Dr. N. Ganeshananthan

Dr. Sarathchandra Kodikara

Mr. T. Perimpanayagam

Mr. A. W. Dissanayake

Dr. N. Pinto

Mr. D. Ganeshan

Dr. P.H. Dissanayake

Dr. Samath D Dharmaratne

Doctors strengthening Tobacco Alcohol policy of the Government

Dr. Manoj Fernando in a report presented on the activities of the SLMA Tobacco, Alcohol, and Illicit Drugs Committee for the year 2007 states that it had worked hard during the last several years to strengthen the Tobacco and Alcohol policy of the government.

The chairperson of the committee is Dr. Sajeewa Ranaweera. Among the activities listed are.

1. Working with GP’s - Strengthening GP’s to help their patients quit smoking

This activity was successfully implemented through the year. About 50 doctors working in private medical practices, including GPs were directly contacted and provided materials, including the booklet “Help your patients quit smoking”, at regular visits to their clinics.

This booklet is distributed among doctors to guide them towards easy approaches to encouraging tobacco cessation. Almost all doctors showed a positive interest and most achieved significant results. This was further strengthened and monitored through follow up visits.

2. Working with hospitals to strengthen doctors to help their patients to quit smoking and declare hospitals as smoke free

We have worked closely with LRH and North Colombo Teaching Hospital in this regard. Most doctors at OPD of NCTH with whom we had an initial session and follow up on several occasions are more active in promoting cessation.

We conducted several awareness programmes for the staff of all categories at the Lady Ridgeway Hospital for children.

The asthma clinics and the Health Education Unit of LRH are particularly active. They use the relevant audio and video materials in their daily health education campaign in this regard.

3. Working with schools

We continued working with schools as both the alcohol and the tobacco trades it deliberately target youth. The SLAAS supported us in this activity by inviting us for their schools ‘Science Day’ programs.

It was a good opportunity to address a large population of school children from outstation schools. We too worked with 3 major schools in Colombo and look forward to work with international schools staff and children.

4. Writing a book to strengthen medical profession to reduce alcohol related harm

We propose to produce a booklet, similar to the one written for doctors on quitting tobacco, about alcohol. It will be a simple set of guidelines for doctors on implementing evidence based interventions to reduce alcohol related harm.

The authors submitted the draft to the committee and approval was given.

5. Working with opinion leaders

We meet several ‘influential’ people from different sectors in order to initiate a dialogue on alcohol and tobacco related issues. People from the media industry and popular artistes were among those that we met.

6. Strengthening the tobacco and Alcohol Policy

The SLMA Committee on tobacco and alcohol has worked hard during the last several years to make this policy a reality.

After its enactment we have monitored its implementation and can offer any technical support requested by the National Authority on Tobacco and Alcohol. We note with satisfaction that Prof. Gita Fernando is a member of the authority.

Simple weight bearing exercises for maintaing bone strengnth and delaying Osteoporosis - Dr. Primrose Jayasinghe

In the final part of her article on Osteoporosis Dr. Primrose Jayasinghe (FRCP) says that according to the experts view with a daily outline of simple weight bearing exercises using simple bean bags or dumbbells for 15 to 20 minutes one could maintain bone strength and delay the onset of Osteoporosis.

A daily routine of weight bearing exercises (such as using simple bean bags or dumbbells) is extremely important to improve muscle mass and bone strength. This is the most obvious direct action one can take.

It seems unnecessary that hours are spent at a gym, unless of course one has no willpower at all. (At least in a gym one may be compelled to participate in an exercise regime!) Instead adhering to a simple daily routine for 10 to 15 minutes when possible is all that experts say, is necessary to help maintain bone strength and delay the onset of osteoporosis to one’s advantage.

The importance is that it should be a regular routine and not a haphazard one. It is equally important to understand that the muscle and bone will return to the original state that they were in when the exercise routine is abandoned.

Balance exercises are another aspect to consider Tai Chi, skipping exercise balls. Yoga etc are accepted means of developing the reflexes needed for righting oneself on losing balance. Having good body balance will help prevent falls that may lead to fractures of brittle bones. Needless to say that participating in sports and outdoor activities will all contribute to a healthy body.

Who could ignore the need for a healthy balanced diet that includes all the necessary vitamins and minerals? For bones in particular, the diet should contain items that would provide the daily calcium and vitamin D requirements together with a adequate amount of protein. As mentioned before milk and other dairy produce are rich sources.

They can be supplemented by a balanced diet containing greens ‘lentils’ meat/fish or eggs. Two to three litres of water a day is recommended for maintaining good circulation and keeping tissues well hydrated.

Sports activities and the habit of partaking of a balanced diet should be encouraged while children are still young so that they not only develop strong healthy bodies which can withstand the onslaught of time but also to inculcate those habits for life.

Adherence to a healthy lifestyle is mandatory if one is to continue being youthful for longer. It will also help delay the start of bone loss as age advances. People with also help delay the start of bone loss as age advances.

People with thyroid and parathyroid disease and those taking steroids for medical reasons should keep their surveillance on their bone healthy by discussing these issues with their doctors. It may be necessary to consider bone-protective medication under certain circumstances for prophylaxis.

If one suspects that one has developed osteoporosis due to age or disease. It would be advisable to seek medical help with a view to assessing bone mineral density that will throw some light as to the extent of the disease process.

Once the diagnosis is established definitive medical treatment needs to be commenced by your doctors to arrest the progression of the process.

Here too adherence to lifestyle modification should be considered in all seriousness as medication alone will not be sufficient to halt the progression into further decline.

If you are someone who may have any of the above risk factors then the time to start a suitable plan of action against the disease is NOW. Prevention is certainly better than cure!

Medical myths

By Dr. Rachel C. Vreeman and Dr. Aaron E. Carroll

(Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA)

Sometimes even doctors are duped. Physicians understand that practising good medicine requires the constant acquisition of new knowledge, though they often assume their existing medical beliefs do not need re-examination.

These medical myths are a light hearted remainder that we can be wrong and need to question what other falsehoods we unwittingly propagate as we practice medicine.

We generated a list of common medical or medicine related beliefs espoused by physicians and the general public, based on statements we had heard endorsed on multiple occasions and thought were true or might be true. We selected seven for critical review:

* People should drink at least eight glasses of water a day

* We use only 10% of our brains

* Hair and fingernails continue to grow after death

* Shaving hair causes it to grow back faster, darker, or coarser

* Reading in dim light ruins your eyesight

* Eating turkey makes people especially drowsy

* Mobile phones create considerable electromagnetic interference in hospitals

We used Medline and Google to search for evidence to support or refute each of these claims. Because “proving a negative” can be challenging, we noted instances in which there was no evidence to support the claim.

People should drink at least eight glasses of water a day

The advice to drink at least eight glasses of water a day can be found throughout the popular press. One origin may be a 1945 recommendation that stated: A suitable allowance of water for adults is 2.5 litres daily in most instances. An ordinary standard for diverse persons is 1 millilitre for each calories of food. Most of this quantity is contained in prepared foods.

If the last, crucial sentence is ignored, the statement could be interpreted as instruction to drink eight glasses of water a day.

Another endorsement may have come from a prominent nutritionist, Frederick Stare, who once recommended, without references, the consumption “around 6 to 8 glasses per 24 hours,” which could be “in the form of coffee, tea, milk, soft drinks, beer, etc.

The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an invited review by Heinz Valtin in the American Journal of Physiology.

Furthermore, existing studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk and even caffeinated drinks. In contrast, drinking excess amounts of water can be dangerous, resulting in water intoxication, hyponatraemia and even death.

We use only 10% of our brains

The belief that we use only 10% of our brains has persisted for over a century, despite dramatic advances in neuroscience.

In another extensive expert literature review, Barry Beyerstein provides a detailed account of the origins of this myth and the evidence disputing it. Some sources attribute this claim to Albert Einstein, but no such reference or statement by Einstein has ever been recorded.

This myth arose as early as 1907, propagated by multiple sources advocating the power of self improvement and tapping into each person’s unrealised latent abilities.

Evidence from studies of brain damage, brain imaging, localisation of function microstructural analysis, and metabolic studies show that people use much more than 10% of their brains.

Studies of patients with brain injury suggest that damage to almost any area of the brain has specific and lasting effects on mental, vegetative, and behavioral capabilities. Numerous types of brian imaging studies show that no area of the brain is completely silent or inactive.

The many functions of the brain are highly localised, with different task allocated to different anatomical regions. Detailed probing of the brian has failed to identity the “non-functioning” 90%.

Even micro-level localisation, isolating the response of single neurones, reveals no gaps or inactive areas. Metabolic studies, tracking differential rates of cellular metabolism within the brain, reveal no dormant areas.

Hair and fingernails continue to grow after death

Morbid information about the body captures the imagination and reinforces medical mythology. In all quiet on the Western Front, the author describes a friend’s fingernails growing in corkscrews after the burial.

Johnny Carson even perpetuated this myth with his joke, “For three days after death hair and fingernails continue to grow, but phone calls taper off. To quote the expert opinion of forensic anthropologist William Maples, “It is a powerful, disturbing image, but it is pure moonshine. No such thing occurs.

This myth does have a basis in a biological phenomenon that can occur after death. As Maples and numerous dermatologists explain, dehydration of the body after death and drying or desiccation may lead to retraction of the skin around the hair or nails.

The skin’s retraction can create an appearance of increased length or of greater prominence because of the optical illusion created by contrasting the shrunken soft issues with the nails or hair. The actual growth of hair and nails, however requires a complex hormonal regulation not sustained after death.

Shaving hair causes it to grow back faster, darker, or coarser

Another common belief is that shaving hair off will cause it to grow back in a darker or coarser form or to grow back faster. It is often reinforced by popular media sources and perhaps by people contemplating the quick appearance of stubble on their own body.

Strong scientific evidence disproves these claims. As early as 1928, a clinical trial showed that shaving had no effect on hair growth. More recent studies confirm that shaving does not affect the thickness or rate of hair regrowth.

In addition, shaving removes the dead portion of hair, not the living section lying below the skin’s surface, so it is unlikely to affect the rate or type of growth. Shaved hair lacks the finer taper seen at the ends of unshaven hair, giving an impression of coarseness. Similarly, the new hair has not yet been lightened by the sun or other chemical exposures, resulting in an appearance that seems darker than existing hair.

Reading in dim light ruins your eyesight

The fearful idea that reading in dim light could ruin one’s eyesight probably has its origins in the physiological experience of eye strain. Subotimal lighting can create a sensation of having difficulty in focusing.

It also decrease the rate of blinking and leads to discomfort from drying, particularly in conditions of voluntary squinting. The important counterpoint is that these effects do not persist.

The majority consensus in ophthalmology, as outlined in a collection of educational material for patients, is that reading in dim light does not damage your eyes.

Although it can cause eye strain with multiple temporary negative effects, it is unlikely to cause a permanent change on the function or structure of the eyes. Even in patients with Sjogren’s syndrome (an autoimmune disease that features inflammation in certain glands of the body), decreased functional visual acuity associated with strained reading improves when they stop reading.

One review article on myopia concludes that increased use of one’s eyes, such as reading in dim light or holding books too close to the face, could result in impaired ocular growth and refractive error.

The primary evidence cited was epidemiological evidence of the increased prevalence of myopia and the high incidence of myopia in people with more academic experience. The author notes that this hypothesis is just beginning to “gain scientific credence”.

In the past reading conditions involved even less light, relying on candles or lanterns, so increased rates of myopia over the past several centuries does not necessarily support that dim reading conditions are to blame. In contrast to that review, hundreds of online expert opinions conclude that reading in low light does not hurt your eyes.

(Sent by Dr. Dennis J. Aloysius Visting Lecture PGIM)