For some cultures and in some families co-sleeping is the norm, and there is no real evidence that it does any long-term harm. For parents who want to put a stop to this habit, the strategy is fairly straightforward, although both parents will need to be certain they want to commit themselves to the process.

The first step is to prepare the child by letting him know that the rules are to be changed, and that now if the child wakes during the night, he must stay in his own bed. During the night, if the child enters the parents’ bed, he is immediately returned to his own bed. There must be no cuddles or conversation — just a matter of fact return to bed. This may need to be repeated a number of times, over a few nights, before the child gets the message.

The next morning the parents should tell the child how good/grown up he is for having stayed in his room all night. The reinforcement of expected and appropriate behaviour is an important part of the strategy.

These strategies will almost always work. If they do not, it is often because parents don’t persist or support each other adequately. Sometimes the help of an interested family doctor, pediatrician or psychologist is a good idea, such a person can act as a sort of ‘coach’ for the parents, especially for the more difficult or stubborn youngsters.

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It is difficult for many people to believe recovery is possible. After trying many different treatment methods without success, it is difficult to believe anything will succeed. If we think something isn’t going to work, then it won’t. That’s our problem—our thinking.

The past belongs to the past-except for one major point. Despite the enormous difficulties we have encountered through the disorder, nothing physically has happened to us. None of our major fears have been realised, and they aren’t going to be in the future. The next attack is not going to be the ‘one’ in which our fears come true. If anything were going to happen to us it would have happened in the first attack. We are continually drawing on our past experiences of the anxiety and attacks and projecting them into the future. We don’t concentrate on what is happening now.

If we always have an attack at 7.00 a.m. we expect to have one every morning. When we have an attack we think ‘I knew it would happen’. We expect to have one the following morning, and we do. We don’t see what is happening now because we are too busy anticipating the next attack.

As an example, we need to be aware of our first thoughts when we wake. The first thought is usually ‘where is it’, and we usually feel frightened because we know ‘it’ is going to be there. We turn on our internal radar and check to see wbat is happening. We move down our body. ‘I’m going to have a headache, my throat is tight, my heart is racing, I am having trouble breathing, I feel sick, I’m shaking.’ And a full scale attack may develop. After it subsides we worry about the next one. As we go to sleep at night we think to ourselves, ‘What if I have an attack in the morning?’

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Commonly, after the sleep issue is resolved, parents notice real difference. The child is more easy-going, less frustrated, happier, and more predictable Parents wonder why they didn’t do something sooner. Parents, too, feel m content and self-confident.

In the long-run, the child’s sense of independence and self-esteem enhanced. When he masters sleep problems, he has mastered an important p of life. (He knows it is important by the significance you—and the rest of world—have placed on it.) Sleep and nighttime can be frightening; child need to know that Mom and Dad are in charge.

A child who continually disrupts his parents’ sleep forms an unhealthy vi of life. He learns that his needs are the only important ones. This is a far from what parents intend.

Perhaps this is the message you would like to send: / love you and I want you to grow up to be a happy person. Sleeping is part life. The way you are sleeping now doesn’t fit with the rest of our family. It becoming a problem for us all. Let’s work on it together.

*7\67\8*

Incontinence falls into two quite different groups. Firstly, there is loss of control of urine or faeces coming through the normal passages. Secondly, there is loss of control of urine or faeces because it is coming away through a passage that doesn’t normally exist. This may be a passage created by your cancer (a fistula) or an artificial opening made surgically (a stoma).

Let’s talk first about incontinence where urine or faeces is coming through the normal passages. This can basically develop for three different reasons, one or more of which could be operating in your case. Firstly, when you can’t tell when your bladder or bowel is full. Secondly, when you can’t control the muscles that empty the bladder or bowel. Thirdly, when the lining of the bladder or bowel is so inflamed that the muscle responsible for emptying it goes into spasm which you cannot control (urge incontinence).

*201/40/1*

Prolapsing piles can lead to a mucoid discharge and soiling of the underclothes.

Sometimes a clot may form in an external pile and this thrombosis produces a hard tender lump which slowly subsides over about five days. It may leave a projecting skin tag which can lead to irritation.

It is amazing how many people will put up with the discomfort of haemorrhoids before seeking treatment. This may be because of embarrassment or because of the unjustified belief that treatment, especially operation, is associated with a lot of pain.

Creams and suppositories to insert into the rectum can produce relief in the early stages. Most contain local anaesthetics and drugs to reduce the congestion. Many tablets, obtained directly from the chemist without prescription, are claimed to reduce or even “cure” piles. These seem to work only because of a mild laxative effect.

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How well she masters this stage and the symptoms which might arise, often depend on her knowledge of, and attitudes to, her own body.

Both sexes go through the changes of puberty as men and women enter their reproductive lives.

But, for a woman, this reproductive phase of her life has a definite end. This is the menopause. For a man, there is no such dramatic change and he may continue reproductive ability into old age.

The female reproductive system is under the control of the pituitary gland, which lies at the base of the brain. This produces hormones or chemicals which act on the ovaries.

Each month, due to these hormones, an ovum or egg ripens in the ovary and oestrogen is formed. This hormone causes the endometrium, or lining of the womb, to build up.

When the egg is released, a further hormone is produced by the ovary and makes the regenerated endometrium soft and spongy, ready to receive the fertilised ovum, if conception has occurred.

*137/71/1*

1. Circle your answer.

Eating patterns

• I eat at least 3 meals a day with no longer than 5 hours in between yes/no

Carbohydrate checker

• 1 eat at least 4 slices of bread each day (1 roll = 2 slices of bread) yes/no

• I eat at least 1 cup of breakfast cereal each day or an extra slice of bread yes/no

• I usually eat 2 or more pieces of fruit each day yes/no

• I eat at least 3 different vegetables or have a salad most days yes/no

• I include carbohydrates like pasta, rice and potato in my diet each day yes/no

Protein checker

• I eat at least 1 and usually 2 serves of meat or meat alternatives (poultry, seafood, eggs, dried peas/beans or nuts) each day yes/no

Fat checker

• I spread butter or margarine thinly on bread or use none at all yes/no

• I eat fried food no more than once per week yes/no

• I use polyunsaturated or mono-unsaturated oil (Canola or olive) for cooking. (Circle yes if you never fry in oil or fat) yes/no

• I avoid oil-based dressings on salads yes/no

• I use reduced fat or low fat dairy products yes/no

• I cut the fat off meat and take the skin off chicken yes/no

• I eat fatty snacks such as chocolate, chips, biscuits or rich desserts/cakes etc. no more than twice a week yes/no

• I eat fast or take-away food no more than once per week Iron checker yes/no

• I eat lean red meat at least 3 times per week or 2 servings of white meat daily or for vegetarians, include at least 1-2 cups of dried peas and beans (e.g. lentils, soy beans, chick peas) daily yes/no

• I include a vitamin C source with meals based on bread, cereals, fruit and vegetables to assist the iron absorption in these ‘plant’ sources of iron yes/No

Calcium checker

• I eat at least 3 serves of dairy food or soy milk alternative each day (1 serve = 200 ml milk or fortified soy milk; 1 slice (30 g) hard cheese; 200 g yoghurt) yes/No

Fluids

• I drink fluids regularly before, during and after exercise yes/No

Alcohol

• When I drink alcohol, I would mostly drink no more than is recommended for the safe drink driving limit (Circle yes if you don’t drink alcohol) yes/No

2. Score 1 point for every ‘yes’ answer

Scoring scale

18-20 Excellent

15-17 Room for improvement

12-14 Just made it

0-12 Poor

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• Biological influences on obesity include age, sex, race, hormonal factors (such as puberty, pregnancy and menopause) and a wide range of genetic factors and interactions between these.

• Recent findings have isolated a number of genes associated with various aspects of obesity such as hunger and food preference.

• The propensity to store body fat increases with age, and there are important age by sex, and possibly racial interactions.

There are multiple biological regulators of body fat. These are, in particular, genetics (including sex and race) and age.

Other biological factors. There are some other notable biological factors influencing tat loss which occur at certain periods of life. These include puberty, menses, and menopause and a wide range of genetic factors. Like most biological influences, these are relatively fixed, and hence modifications have generally not been seen as a realistic approach to dealing with the problem. The implications of these biological influences are in accepting factors beyond the control of the obese person. Obesity can no longer be simply ascribed to either ‘sloth’ or ‘gluttony’.

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