Older children, in addition to the reactions described, may feel guilty that they are somehow responsible for the separation, believing that if they had behaved better or differently, it would not have occurred. Often there is yearning for the absent parent. Sadness and even overt depression are common.

Adolescents may feel intense anger at one or both parents, and may feel loyal and protective to one of the parents. Somatic complaints, such as stomach aches and headaches are common, and there may be problems with schoolwork and with peer relationships. Acting-out behaviour (such as talking back or open hostility) common to adolescents, may be accentuated. One of the developmental tasks of adolescence is to separate from the family, and this is made more difficult if there is separation and divorce during this period. They worry about their own ability to have successful relationships later in life.

*144\90\8*

Your doctor may say that twenty tablets per prescription is the maximum he or she can prescribe. This is not true. In Australia, your doctor can apply to the Department of Health for permission to give you enough painkillers per prescription to last one month. Permission is always given for people with cancer. Find out from a doctor or pharmacist what regulations apply in your country.

If you are in hospital, you have to rely on nurses as well as doctors to get the painkiller you need. First, ask your doctor to write up your painkiller to be taken regularly, (every three to six hours as is appropriate for the particular painkiller), not ‘as required’. If it is written up ‘as required’ you will have to ask for every dose. Even once you persuade the nurse you do need it, you will have to wait while senior nurses and keys are found, so cupboards can be unlocked to get your painkiller out. You shouldn’t have to go through this and you won’t have to if you can persuade your doctor to say you must have the painkiller regularly.

*181/40/1*

(2.) Assume command (someone has to). (3.) Assess the situation …

Any injuries?

How many?

How bad?

(4.) Delegate specific people to do specific things; particularly with road accidents. Block traffic or divert vehicles on one side of the accident (many a minor injury has been converted to a major one through a car ploughing into the injured person on the road). Send someone to phone police and someone else to phone for an ambulance.

(5.) Move the patient out of danger if it is not practicable to block the traffic. If you worsen the injuries by moving the victim, this is better than the injured — or yourself — being killed by another car.

(6.) Remember the A-B-C of saving lives …

A is for airway. Is he breathing? If not, start artificial respiration. If breathing, check whether it is easy or labored respiration. If he is unconscious and lying on his back, lift his lower jaw upwards and forwards. This lifts the tongue, stopping it from falling back and blocking the airway. Take out false teeth!

 is for bleeding. Look for bleeding, then stop it. Direct pressure will nearly always stop brisk haemorrhage. Put your THUMB on it, or your hands. Pads and bandages are great, but take time. Remember. NO TOURNIQUETS!

Ñ is for conscious state. If unconscious, check the airway as above, turn the head to one side, or, if there is no other apparent injury, place the patient on his side, so that in case of vomiting the vomitus cannot enter the lungs.

R … to that A-B-C let’s add an “R” — Re-assess! Keep going back over the A-B-C.

*624/71/1*

Food poisoning due to toxins usually develops within four to six hours but those cases due to infection with bacteria or viruses may take 12 to 24 hours to develop. Food may be contaminated with chemicals, especially the heavy metals and then symptoms come on quickly, usually within one to two hours.

If you want to avoid this unpleasant group of illnesses, some simple precautions may help. You would be wise to avoid food which appears “off”, in any way. If the color, smell or taste gives an indication that all is not well, leave it alone. This applies to left-over foods at home as well as those you buy.

Foods which are kept warm for long periods are prone to contamination. Look at the standard of cleanliness in the shop. If it is generally good, the owners probably take care of the food as well as the premises. Sloppy people tend to be sloppy in all things.

*367/71/1*

The endometrium is the layer of cells which forms the lining of the uterus or womb. It is this layer which is under hormone control and builds up and becomes thick and spongy, ready to receive the fertilised egg should conception occur.

If it doesn’t this layer of tissue is shed, along with a certain amount of bleeding, and is the menstrual flow which constitutes a woman’s period.

In endometriosis, some of this endometrial tissue is found in other areas. It may be present deep in the muscle layers of the womb itself, in the ovary in the ligaments which hold the womb in place or on any of the abdominal organs. Why this tissue should be present in an unusual position is uncertain.

The problem with this condition is that the ectopic, or “out of place” cells react in the same way to the hormonal changes as the cells in their proper place. They build up, increase their blood supply and then shrivel up and bleeding occurs at the time of the period.

*117/71/1*

*148/40/1*

Food manufacturers are increasingly interested in having the G.I. of their products measured and the G.I. concept is already being discussed on the back of some commercial breakfast cereals. As more products are measured and consumer awareness of glycaemic index increases, we may see manufacturers highlighting the glycaemic index of foods. As consumers, people with diabetes should lobby Diabetes Australia if they believe the information should be on food labels.

Can I still lose weight eating as much carbohydrate as I want?

Possibly not. We recommend a high carbohydrate intake and a low fat intake. While carbohydrate is not usually stored as fat, if you are eating more energy in total than your body requires, then the carbohydrate will be used as a source of fuel in preference to fat. This would have the effect of limiting the breakdown of body fat stores. The idea is to eat enough energy in total to satisfy your appetite (using low G.I. types helps) and nutritional requirements but not more than you need. An increase in your activity level will help burn up body fat as it used as an additonal fuel.

Should I only eat foods with a low G.L?

No, that is unnecessary. You can lower the G.L of your diet effectively by substituting approximately half of your carbohydrate with low G.L types. When we eat a high G.L food with a low G.L food we end up with a meal of intermediate G.L so high G.I. foods needn’t be excluded. It is also generally healthier to eat as wide a variety of foods as possible, so don’t narrow your food choices unnecessarily.

Everybody can benefit from adopting the G.I. factor approach to eating. It is the way nature intended us to eat.

*97\42\4*

loss.

2. Patients with a genetic predisposition to obesity or with a long history of obesity should have their previous exercise history carefully considered before any prescription as to the type of planned physical activity is given.

3. More attention needs to be given to duration, frequency and intensity of physical activity with pre-menopausal women and particularly those with gynoid-form obesity.

4. Greater attention needs to be paid to the combination of diet and physical activity in the case of long term obesity.

5. More emphasis should be placed on energy input in the initial stages of severe obesity with activity limited to incidental activity or weight-supportive exercise.

6. Consideration needs to be given to the different fat loss responses to exercise in post-menopausal compared to premenopausal women, and in android compared to gynoid forms of overfatness.

7. There is a need for greater attention to spontaneous activity in older patients. This tends to decline naturally and may do so even further after the introduction of a planned, daily physical activity session.

8. Different levels of intensity of physical activity may be required for clients with different levels of cardiovascular fitness.

9. It should not be assumed that individuals of equal fatness have equivalent cardiovascular fitness. Prescription needs to be specific to each individual.

10. For programs that are gym or fitness centre based, provision needs to be made for organised physical activity on days when the gym is not used (i.e. making up a total of 6-7 days/week of organised physical activity).

11. It should be recognised that total energy use and substrate utilisation can vary between individuals depending on gender and age. These variables need to be recognised in developing any individualised prescription.

12. It should be recognised that many people over-estimate the amount of physical activity they carry out during the course of a day. Hence, activity diaries, or pedometers or other measurement tools are suggested to keep track of daily efforts.

*161\186\4*