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The conferenoe next oonsidered the problEll1s inherent in conduoting social-psychological research into disasters anxiety 1 discount zyban master card. The National Opinion Research Center reported in detail its experience depression symptoms during menstrual cycle order zyban without a prescription, including the administrative depression symptoms after surgery generic zyban 150 mg mastercard, technical, and analytic difficulties which arise. Techniques of research, notably interviewing techniques" were discussed, and the conference heard reports ot field investigations~isastersfrom three contractors of the ~ Chemical Center-the Department ot Psychiatry, University of Maryland School of Medicine; the Department of Clinical Science, University ot Illinois CollejSe of Medicine; and the National Opinion Research Center, University of Chicago. This section of the conference closed with discussion of some of the unresolved problems in disaster research, including those oonnected with the selection of disaster incidents for investigation, the timing of field investigations, the use of credentials in field investigation," the substantive analysis ot the field materials colleoted and the need for greater coordination among the various disaster research projects. Social psychological research into disasters should be oriented toward the practical objeotives ot understanding how people respond to disasters in order to be able to supply information as to the probable effect of a disaster on the efficiency of functioning of a community and its inhabitants and as to means of minimizing any impairment of functioning that may occur. The plan to coordinate all such disaster researoh under the National Research Council will serve to increase the effectiveness of and value of this research. All agencies represented at the conference indicated their intention to support and cooperate with this plan. The disaswr research whioh has thus far been carried out ~e conference further made two reoommendatioM in support ot some ot these conclusions 2 1. Widespread disaster reporting Bystems should be established under the jurisdiotion ot the Disaswr Researoh Co:mm1"btee ot the Bational Researoh Council. You will find at your place a statement of the agenda as it stood yesterday afternoon. The afternoon meeting, as you will note from a glanoe at the agenda, is conoerned primarily with some considerations pertaining to methods of research in this area, with an appraisal of our own past experienoe, with some discussion of teohniques of research in whioh the lIaryland people and the National Opinion Research Oenter will take the lead. Tomorrow will be ooncerned still more conoretely with reports of field investigations of a speoifio sort. In the afternoon, tomorrow, we will be conoerned wi th a disoussion of unresolved theoretioal and practioal problElllS, incident to the study of disasters. Back in 1948 there was a conference on the psychological research in Chemical Corps; and in 1950 there was one more closely related to this, named the psychological aspects of disaster. This then is by way of being a progress report, I take it, continuing fran last year. From our point of view, when we think over what we want, we renect that in canmon with all ether military groups we have two objectives-of offense and defense. We are quite cognizant that the terriЈy1ng and consequently destructive aspects on the community, be it military, or civilian, of any weapon is one of the major factoTs in its effectiveness. These fearsome aspects of weapons are particularly characteristic of those Which the chemical corps is responsible for; namely, chemical or gas warfare, biological warfare, radiological or atomic warfare. Now, to come to the Medical Laboratories of Chemical Corps, which is the group we are representing, the Medical Laboratories are actually predicated on a policy of long range or basic research, against which background, using the most adequate available scientific methods, it attempts to give immediate answers, immediate and practical answers on military questions. Such altered behavior, which may be merely apprehension or amdety or fear or actual panic, as is to be expected, disrupts jUdgment and constitutes a very real hazard. Anry Chemical Center recognized that in dealing with the nerve gases we had some rather unique chemical agents that had a potential tor psychological effects which were considerably greater-really at a difterent order ot magnitude than anything we had already encotmtered, and that we had psychological problems that we had:not yet met. We talked wi th many consultants, and the result ot i"li eventually was our contract with the National Opinion Research Canter, certainly as an initial construotive move. We have not been subjected to a major attack by enemy action from any weapon in many, many years, certainly. It became our beliet, rather early, that the only way to gain any such information was to study the. So my early move was to contact my counterparts in the Navy and the Air Force, in particular, and I obtained ready agreement from them that the problems were of equal importance to all of the services. And so Captain Christopher ShaY and Captain Charles Sohilling, of the Navy, respectively the Bureau of Medicine Surgery and the Office of Naval Research, and Colonel A. Gaggey of the Air Force, and I sat down and pooled our information on What are the problems as we could foresee them that would necessarily arise in a major disaster, and what sort of investigations, as a preliminary straw man type of protocol, we would envision for such research; the idea being that this wou14 be circulated widely for criticism to as many groups as we thought had any interest and to as many experts as we could lay hands on, and that appropriate revisions would be made and this would be presented to the office of the Secretary of Defense I s Research and Development Board. This was done, and it became clear at that time that the Civil Defense and Federal Civil Defense Administration certainly had an interest as great as that of the Department of Defense in this field, and,furthermore, by lsw they had a responsibility in this field. So it was agreed that the best arrangement would be to draw up a joint program with the Federal Civil Defense Administration, and this was done by several conferences. I thi-nk, first, before stating the objective of this plan, every investigation must have a logical basis or reason for its existence. I think perhaps it might be well just to state, in a very fevr words, why we think disasters ought to be investigated in the first place. The pcmer of modern weapons is so great that the impact is likely to be sudden and of catastrophic proportions, and to impose upon a people a major disaster aituation perhaps as great as, if not exceeding, anything that we have seen in the past. We must think in terms of the atomic weapon as perhaps the premier weapon of mass destruction. The Air Force, furthermore, has published in the newspapers that it is not feasible for any air defense, even radarassisted, to prevent more than ab~lt thi. That being the case, there is a real likelihood of an atom bomb attack succeeding against a given target. I am sure that you have all read the approximate potential of the so-called standard or 20 kilo-ton atom bomb; that we expect probably in excess of 50,000 casualties. Fifty thousand casualties in any given location, I assure you, is a major disaster. It disrupts the community to the extent that it cannot recover certainly for many days, and it essentially knocks out the target for quite a long time. Novr,turning to other possible new weapons, I shall say very little about the field of biological warfare because this is an untested, untried field. Certainly, it will not be of the sudden catastrophic type occasioned by an atomic explosion, because the results of biological warfare develop slowlY over a period of days to even weeks. Nevertheless, if the major effects hoped for should occur, then at the time of the development of large numbers of casualties there will certainly be major psychological upsets of the types which occurred when we had great epidemics of yellow fever in our ports, for example, in Philadelphia and Newr Orleans, back at the tum of the century or before. It probably would have an impact much like biological warfare, and ma,y not be actually adequate as an anti-personnel weapon, but rather an area denial weapon, which will force people to leave an area and offer really great obstacles to its reoccupation and use. Finally, I think we arrive at the field of chemical warfare among the special weapons. This is not to discount the use of other chemicals at short range when an enemy has obtained a 10dgSll. But I think initially we are tallcing in chanioal terms only about the nerve gases. Now, I do not wish to give an exaggerated idea of the potential of the chemioal weapon, because against a prepared people who have at hand adequate defense in the form. It then becomes a problen of how ~people are surprised and attain a dangerou8 amount of gas before they use such proteotion. So the objeotive in this proposal was first to determine the mass and individual psychological reactions of our people in major disasters, sooiological upheavals Which are brought about by these disasters, and the resoue, medioal and logistio problens involTad in adequately handling these disaster situations.
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Mediante la reflexiуn Constituirбn el йxito y el triunfo final de nuestros buenos deseos їQuiйn no se equivoca? La gloria no consiste en no caer nunca depression scale 150 mg zyban with amex, sino mбs bien en levantarse todas las veces que sea necesario depression test calgary order zyban toronto. Me inclino a dudarlo mood disorder blogs buy zyban visa, pues en mi caso intervinieron excesivas condiciones particulares. Puedo asegurarles, sin embargo, que ha significado mucho para mн, que ha sido mucho lo que me han dado en los aсos que aprendн. Asн, reciban mi mбs cбlido agradecimiento por los dнas pasados tanto como por el dнa de hoy. Haz que hasta los diez aсos the tema, hasta los veinte the ame y hasta la muerte the respete. Hasta los diez aсos sй su maestro, hasta los veinte su padre y hasta la muerte su amigo. Piensa en darle buenos principios antes que bellas maneras; que the deba rectitud esclarecida y no frнvola elegancia. En nuestra experiencia las complicaciones fнsicas y las repercusiones en el funcionamiento fisiolуgicos de diferentes уrganos del cuerpo es una respuesta a un malestar que sobre paso al individuo. No se trata de un ideal lejano e inalcanzable sino de algo tan sencil sencillo y natural que a menudo lo pasamos por alto. Por eso cuando el evento se presenta es como una gran ola que the arrastra y the revuelca sacбndote de la realidad. Podrнamos afirmar que lo sobrevivimos dentro de una locura interior sin mayor entendimiento ni direcciуn. Al vivir el duelo entiendemos del dolor, en el proceso duele todo e inexplicablemente vivir duele. Nuestro desconocimiento y lo que pensamos de la muerte nos ha llevado a tenerle miedo, a no querer saber de este proceso natural considerado diferente a la felicidad del nacer. Ciertamente nuestra visiуn occidental de la muerte nos influencнa a que no lo aceptemos como un proceso de regocijo y felicidad. No hablamos del tema, lo ocultamos, lo evadimos, lo ignoramos o fantaseamos para engaсar nuestros propios temores y desconocimiento del tema. La represiуn de las intensas emociones del duelo se reflejan en nuestro cuerpo a travйs de las enfermedades. La perfecciуn del funcionamiento del cuerpo humano nos asombra al entender sus mensajes y llamadas de atenciуn que realiza a travйs de los sнntomas y signos. Tenemos muchos conocimientos especializados pero tenemos un gran desconocimiento del manejo emocional en nuestra vida. Actualmente se estбn realizando importantes esfuerzos pedagуgicos en las escuelas con el fin de adquirir conocimientos emocionales. Nos gustarнa un dнa ver integrado en un programa escolar la enseсanza tanatolуgica que beneficiarнa ampliamente al vacнo existencial de las generaciones actuales. Regresemos a nuestro interior, busquemos nuestras respuestas internas, regresemos a la naturaleza, rescatemos la sabidurнa ancestral y la relaciуn con nuestro ser, la vida y el cosmos; valoremos y aprovechemos los grandes avances de la tecnologнa mйdica convencional y la riqueza de la medicina alternativa. Tenemos la gran oportunidad de ayudar a otras personas a reencontrar su camino y acompaсarlos en su proceso de pйrdida, sanaciуn o muerte. La intensidad emocional con que se vive el proceso del duelo nos enseсa de una manera oscura e indeseable a ganar al final. Porque despuйs de que la muerte pasa por nuestra historia la vida no vuelves a ser la misma. Cuando el proceso del duelo lo hacemos a travйs de un trabajo tanatolуgico serio y comprometido entiendemos el verdadero sentido de la vida, podemos ver al otro lado de la barda para reconstruir un nuevo yo, mбs feliz y agradecido, sin medirnos desde lo que hemos perdido sino con todas las bendiciones que si tenemos hoy y que hacen que cada dнa valga la pena ser vivido en plenitud. Las fuerzas naturales que se encuentran dentro de nosotros, son las natur que verdaderamente curan nuestras enfermedades. Es importante conocer la naturaleza de las emociones, como se originan, sus clasificaciones, su relaciуn con la mente, el cuerpo y la enfermedad. En este capнtulo conoceremos del tema de las emociones como punto de partida y origen de la enfermedad. Emociуn proviene de "motere" que significa mover y "e" que significa alejarse, es "aquello que nos impulsa a movernos hacia". Toda emociуn conllevan a una acciуn como respuesta adaptativa del organismo ante un estнmulo. Estas respuestas emocionales son mбs rбpidas pero mбs imprecisas que las respuestas racionales. Nuestro cerebro cuenta con una mente emocional y otra racional que trabajan en armonнa. En equilibrio la mente emocional alimenta e informa las operaciones a la mente racional, la mente racional filtra y a veces frena la energнa de las emociones. Mientras mбs intensos son los sentimientos mбs nos domina la mente emocional y mбs ineficaz resulta nuestra mente racional. Las emociones se manifiestan en pocos segundos y se deben a la amнgdala del cerebro que recibe la informaciуn sensorial captada por los ojos, oнdos y уrganos sensoriales. Esta informaciуn es enviada como seсales a la amнgdala en el cerebro lнmbico causando una reacciуn, sin que entendamos muchas veces que nos pasу o porque reaccionamos asн casi en un instante. Dependiendo de la intensidad de los sentimientos domina mбs la mente emocional sobre la racional. La reacciуn mental ante una emociуn depende de nuestros pensamientos, nuestras creencias, conocimientos previos, objetivos personales, нntimamente ligados a lo que es importante para nosotros. Esta intensidad emocional esta relacionada a la forma subjetiva en que interpretamos la informaciуn y como va a afectar nuestro bienestar. Existen emociones buscadas en las que se manipula un sentimiento intencionalmente a travйs de la mente racional y se dirige a esa sensaciуn provocando la emociуn a travйs de los pensamientos. Las emociones secundarias son las explicaciones mentales de una emociуn primaria, que se contamina por la sociedad y la familia. Un reciйn nacido bбsicamente contacta con el placer y el displacer, antes de los 2 meses ya desarrollу la alegrнa, el disgusto, la aflicciуn y el interйs. Hay muchas opiniones de cuales son las emociones primarias y secundarias pero muchos teуricos consideran las siguientes: 1) Ira: (Fuerza interior para decir yo puedo) indignaciуn, aflicciуn, ultraje, furia, animosidad, fastidio, resentimiento, cуlera, exasperaciуn, hostilidad, irritabilidad y en su extremo: violencia y odio patolуgico. Asco: Disgusto, desdйn, desprecio, menosprecio, aversiуn, aborrecimiento, repulsiуn Vergьenza: Molestia, culpabilidad, disgusto, remordimiento, humillaciуn, arrepentimiento, mortificaciуn y constricciуn. Dolor: (ganas de escapar del propio cuerpo) Reacciones emocionales Acompaсadas de nuestras vivencias emocionales hay reacciones involuntarias a nivel fisiolуgico y reacciones voluntarias como expresiones corporales o verbales, comportamientos o acciones. Las reacciones emocionales se conocen como: 1) Neurofisiolуgicas: ruborizaciуn, taquicardia, sequedad en la boca, secreciуn hormonal, respiraciуn agitada, presiуn sanguнnea, entre otras. Nuestro temperamento heredado nos predispone a cierta personalidad pero es el entorno en nuestros desarrollo de la vida quien va marcando nuestro temperamento que refleja la forma en que respondemos a los estнmulos del entorno. En sн, todas las emociones tienen una funciуn que motiva a la conducta adaptativa del entorno, informativa como seсal de aviso y social en la comunicaciуn con los demбs. Las emociones tambiйn pueden estar presentes en los trastornos emocionales como la depresiуn clнnica y la ansiedad constante e intensa. Diferencia entre emociуn y sentimiento Las emociones son el conjunto complejo de respuestas quнmicas y neuronales que forman un determinado patrуn.
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They were very strongly involved psychologically because of their close identification with their family and other primary group members who were in the danger area mood disorder webmd buy 150mg zyban free shipping. A second crucial feature of the pr esent disaster was the inability on the part of the residents to depression symptoms in child purchase zyban 150mg without a prescription arrive at a self depression blood test developed effective zyban 150 mg. It shatterod a number of the relatively stable norms which enable individuals consciously or unconsciously to direct their behavior. It is ordinarily taken for granted, for example, that the grotmd on which one walks will not erupt or that homes will not suddenl~- explode. Such normal assumptions, in the present case, were to a considerable degree shattered. People were confronted not only with a dangerous situation but also a situation in which many of their usual expeotations no longer applied. Thero was the need for re-definine; or restructuring the s1tuation so that they could mobilize their action to reduce or cope with the threat. In this case, however, the difficulties in arriving at a satisfactory definition of the situation were especially compounded because of the tmpredictability of the explosions. The affected people could discern no patterns to the explosionsf they seEllled completely random and haphazard. In order to direct his aotions, an individual must have certain stable reference points; he must, with a fair degree of accuracy, be able to predict wlla t will occur to the object toward which he is directing his behavior. In Brighton, the seeming irregularity and random character of the explosions prevented any such predictions and hence most persons experienced feelings of great uncertainty and helplessness. Because they oocur unexpectedly, the populace is unable to ereot adequate physical, psychologioal or social defenses. The social and psychological adjustment, therefore, is basioally oriented to a danger that is already past. Hence, it required sooial and psyohologioal adjustment to a future danger, rather than a danger already past. The residents were able to do little in the way of erecting subjectively-satisfying defenses against the crisis. Generally speaking, therefore, even though the threat was continually in the future because of the time span involved, the social-psychological consequences were more comparable to those that follow upon an instantaneous type of disaster. Under conditions of stress, there is a tendency for perception and attention tc be narrowed and focalized-with each person defining the situation almost solely in terms of the objects which are ~ediately perceivable. This tendency can be noted in the initial reactions of the persons in the disaster-struck area of Brighton. Each person tended to interpret the nature and extent of the crisis in tems of his inunediate surroundings. The mass exodus fromthe houses was, for the most part, a result,of the convergenoe of individually-formulated definitions of the situation. Many people in their houses at the moment of impact defined the situation as dangerous and. It was only after these individual escape actions had been taken that most persons realized that the event was more than just a localized accident confined to their own homes. Once outside, such persons came to realize that their escape aotion had not relieved the danger; rather, they found themselves confronted with a further and more extensive danger situation. Houses were exploding all around them and the eruption of the very ground on which the,y stood presented itself as a definite possibility. As has been pointed out, the mode of coping with this further threat was not ~ediately clear; hence, the situation produced feelings of great fear, uncertainty, and helplessness. As is generally true under such circumstances, individuals began to interact with one another. Although their initial escape actions from their homes were, for the most part, the result of individual effort, the later reactions can only be lmderstood in tenns of the collective behavior that occurred when persons came into contact with others in the disaster-struck area. Wi th the occurrence of an axciting or dangerous event~d the breakdown of the usual social expectations. Thus, in Brighton, the residents of the various houses began to converge and congregate in the streets. Under conditions of stress and danger people become highly sensitized to the actions of others. At least three different types of collective behavior emerged out of the numerous, but separate, small milling groups scattered in the streets and lawns throughout the affected area. By far the most common activity that emerged out of the interaction of members of. As people talked over the event among themselves they would decide that some particular location. As they milled, the collective excitement was intensified and the reinforced "not knowing what to do" feeling was vented in unrestrained physical movements. The evidence suggests that this expressive ~e of crowd behavior occUrred in only a few isolated instances and apparently lasted for only a brief time. Other small groups which milled in the streets cOllectively defined the situation as highly threatening and something which required escape action or flight. There was a tendency to respond rather quickly to some suggestion of action on the part of others. From the point of view of personal safety, the only objectively maladaptive behavior;. In most cases this was done in order to obtain car keys which the resident had left behind. But for the people who engaged in such an action, it was an adaptive, rational response, for it was felt that by obtaining the car keys they would be able to drive out of the area and thus remove themselves from further danger more quickly. While there was much confusion and oonsiderable social disorganization, there was nothing approaching a complete breakdown of the whole social structure of the conununity or the neighborhoods. Similarily, there were only a few cases of rather complete personal disorganization. Only in some extreme oases of hysterialike behavior was there activity of an almost wholly l. The evidence indicates that this behavior, for the most part, was short-lived; it tended to be present only during the height of the crisis period. This was true not only of those people who were in the scattered small groups in the immediate disaster-struok area; rumors were also ciroulated by those people milling in the crowds that had quickly gathered at peripheral points-particularly at the road blocks that barred entrance into the disaster area. The initial rmnors that circulated in the immediate disaster area seemed to be about objects outside the area itself, particularly with what had happened to the school and the children. As the mothers observed the houses exploding and catelling fire around them, they became concerned that the nearby schoo 1 might also have been affected. On the other hand, there appeared to be few rumors about the cause or the nature of the explosions themselves. People had rather quickly established that gas was the cause of the explosions which they heard and witnessed. They had no need to speculate for they thought that they had the facts, as they actually did. At the peripheral points, on the other hand, the rumors were about what had happened or was happening in the area.
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Reflections Now that you have thought about what matters to anxiety zone ebola purchase zyban 150 mg overnight delivery you in all of these areas anxiety in dogs purchase 150mg zyban, what is your vision of your best possible self? After completing the Personal Health Inventory great depression definition us history generic 150mg zyban mastercard, talk to a friend, a family member, your health coach, a peer, or someone on yourCare & Cultural Transformation areas you would 2017 to explore further. You have explored shared goal setting and how to set agendas for Whole Health visits. The next chapter will focus on the next steps-creating the plan, helping with skill building, and arranging for ongoing follow up and support. As you read on, keep thinking about how you can draw in these elements of personal health planning into your work. Available under "Key Resources" on the main Whole Health Library webpage at projects. In order to do it, you need to know the patient very well-including, of course, why their health is important to them. You also need to know what resources are available to them, not only from your care team, but also from your facility at large and from the outside community. For example, imagine you are seeing a person with neck pain, and you want them to receive acupuncture. Similarly, you need to know the efficacy and safety of acupuncture for this purpose, as well as who offers acupuncture in your facility or in the greater community. During Whole Health courses, when they are first learning about how to do Whole Health visits, clinicians often become quite concerned about having the time to incorporate this model with everything else they must do when they are seeing a Veteran. It is not something simply discussed in a visit with a primary care provider, or a hospital discharge planner. Sometimes, simply listening and offering compassion is sufficient to promote Whole Health. Other plans may be more detailed, if there is time, and cover multiple aspects of the Circle of Health. Early on in their training, Integrative Medicine fellows write detailed, comprehensive plans, but rarely will a patient be able to follow every suggestion. Ask them how much they can handle, and make good use of follow ups with various team members so that the plan can keep evolving. Your first order of business is to synthesize all the information at your disposal. The patient should always leave the room with a clear sense of next steps with visits, procedures, etc. Be mindful of cultural issues as well, remembering that just because a person belongs to a particular culture does not mean you automatically know who they are or what they believe. Ask them how they believe their culture influences who they are and what they want from their care team. Have tools and educational materials on hand to help with education and skill building. Similarly, become familiar with various resources you can recommend in a health plan. Research indicates you will be rated as much more believable if you model healthy behaviors and, when appropriate, briefly share you own health experiences with patients. What are some of their favorite resources for various parts of the Circle of Health? Initially, clinicians report it takes about 8 extra minutes to incorporate it into their work. Remember that not all aspects of Whole Health have to be addressed at every visit, and in general, plans may not change for some time. Concerns About Time Clinicians often raise concerns about having enough time to use the Whole Health approach. Once you know a person fairly well, future conversations are actually more efficient. An inpatient stay may be a great opportunity to focus on Whole Health in great detail. And it is important to remember that your presence, in and of itself, can promote Whole Health. This is true because of who you are and how you relate to other people, not just because of the plan you create. Goal setting is an important organizing principle in personal health planning, because it is closely linked to adherence. We know that in a typical practice, as many as 50% of medications are taken incorrectly. Shared Goals: Where Veteran and Clinician Goals Intersect Importance Ruler There are two "rulers" that can be helpful with shared goal setting. Follow-through is only going to happen when people truly feel that doing something matters a lot to them. Agenda Setting Clarifying patient and clinician agendas is at the heart of shared goal setting. However, patients are not always forthcoming with what the visit is really about for them. If people have a physical symptom or problem as their main complaint, they only bring it up to their doctor as their first complaint in a visit 50% of the time; the rest of the time, they hesitate or bring it up later. Sometimes, it can feel like what the patient needs from the visit and what the clinician needs are on different "sides," and only one side can win. In fact, a 1981 study by Starfield and colleagues found that in 50% of visits, the doctor and the patient did not agree on what was the main presenting problem. A 1979 study found that 54% of symptoms and 45% of concerns were never elicited in doctor-patient visits. Mindful awareness of what you want to accomplish will allow you to offer more effective care. Beyond listing their concerns, see if there are specific intentions related to those concerns. For instance, a patient may want to have a particular test or see a certain specialist. If time is limited, you can ask, "What is the one thing that you want us to be sure and take care of today? If you have the ability to make use of continuity and follow-up visits, this can allow for some leeway. A good rule of thumb is that if you feel like you are working harder than your patient to address a certain issue, it may be time to reassess how important a given topic is for them. Often, a clinician may be focused on the disease process or a lab number, while the patient may be much more interested in how the disease will affect daily function, or what they saw about a topic on the Internet. See the example in Table 3-1 of two different ways a clinician could bring up the goal of improving blood sugars. That means your sugars have been really high for a while, and we need to bring them down. Keeping your sugars in a good place will help your heart, legs, and the rest of your body be up for it!
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The smaller terminal branches from these two divisions include temporal depression era recipes buy 150 mg zyban amex, zygomatic mood disorder test discount 150 mg zyban, buccal depression symptoms of bipolar disorder generic zyban 150 mg fast delivery, mandibular and cervical. This network of terminal divisions and branches of facial nerve supply all the muscles of facial expression (except levator palpabri superioris) and form pes anserinus (goose-foot). Table 1 shows the terminal branches of facial nerve in parotid gland, the muscles they supply and the methods of their testing. Stylomastoid artery, branch of posterior auricular artery: Mastoid and tympanic segments. Oval window and horizontal semicircular canal: the tympanic segment is situated above the oval window and below the horizontal semicircular canal. Short process of incus: Facial nerve lies medial and inferior to the short process of incus at the level of aditus ad antrum. Pyramid: Facial nerve is situated posterior to the pyramid and the tympanic sulcus. Tympanomastoid suture: the vertical mastoid segment of facial nerve lies about 68 mm deep to this suture and always runs behind the level of this suture. Digastric ridge: Facial nerve leaves the mastoid through the stylomastoid foramen, which is situated at the anterior end of digastric ridge. Parotid gland blood Supply Following are the arteries and areas of facial nerve supplied by them: 1. It is a sharp triangular extension of tragal cartilage, which seems to point towards facial nerve. Styloid process: Facial nerve lies on the posterolateral aspect of the styloid process near its base. The facial nerve lies between the mastoid and the posterosuperior part of the posterior belly of digastric muscle. The facial 258 nerve passes downwards, forwards and laterally immediately above the upper border of digastric posterior belly. Mastoid process: Follow the anterior border of mastoid process up to the vaginal process of tympani bone. A bundle of nerve fibers forms a fascicle, which is enclosed in a sheath called perineurium. The degree of nerve injury determines the degeneration and regeneration of nerve and its function. Traditionally nerve injuries are divided into three types: neuropraxia, axonotmesis and neurotmesis. First degree (obstruction to axoplasm) neuropraxia: In this conduction block, flow of axoplasm through the axons is obstructed. Second degree (injury to axon) axonotmesis: There is loss of axons, but endoneurial tubes remain intact. Complete ear, nose, throat, head and neck examination including ear microexamination, hearing tests and audiometry. Central nervous system examination: Especially cranial nerves, cerebellum and motor system. Determine whether the palsy is complete or incomplete; segmental or uniform involvement. Section 2 w ear A house-brackmann System of grading facial nerve Palsy Facial weakness can be subtle, moderate, near total or total. House-Brackmann system of grading facial nerve palsy (Table 2) has been widely used (endorsed by the American Academy of Otolaryngology-Head and Neck Surgery). This patient also had associated left side abducent nerve lateral rectus palsy Involuntary emotional expressions and the tone of facial muscles remain intact. Central facial paralysis is caused by cerebrovascular accidents (hemorrhage, thrombosis or embolism), tumor or an abscess. Nuclear palsy: It is identified by associated paralysis of 6th nerve, the nucleus of which is situated near to the motor nucleus of facial nerve. Lesion in the bony fallopian canal: From internal acoustic meatus to stylomastoid foramen the lesions can be localized with the help of topodiagnostic tests. A lesion in the parotid area: It affects only the terminal branches of the nerve, which may be involved by the tumor or injury. Electrical tests show rapid and complete degeneration, with loss of voluntary motor units. Third degree (injury to endoneurium) neurotmesis: It is an injury to nerve fiber along with both Wallerian degeneration and loss of endoneurium. The fourth and fifth degrees happen in surgical and accidental traumas and in neoplasms. Facial nerve regeneration: the regeneration and degree of return to normal is dependent on the degree of initial injury (neuropraxia vs. The most important factor in history is whether the palsy developed slowly over days or immediately at the time of the injury. Interpretations: They are: Conduction block: There is no difference between the normal and paralyzed side. Frontalis muscle movements are retained due to bilateral innervation of upper part of motor facial nucleus. Interpretations: 2530% decrease in lacrimation indicates that lesion is proximal to the geniculate ganglion. The greater superficial petrosal nerve carrying secretomotor fibers to lacrimal gland arises from the geniculate ganglion. Stapedial reflex: Stapedial reflex is lost in the lesions that lie above the nerve to stapedius. Impairment of taste sensation indicates that lesion is above the origin of chorda tympani. The peak-to-peak amplitude is directly proportional to the number of intact motor axons. The response of paralyzed side is reported as a percentage of response on normal side, thus telling the proportion of fibers that have degenerated. Interpretation: Fall of summating potential to 10% of the normal value is an indication (90% degeneration) for the surgical decompression. Section 2 w ear Electromyography It records spontaneous activity of facial muscles at rest and on voluntary contraction. The test provides information regarding intact motor units in acute phase and detects reinnervation potentials. Interpretations: They are Normal: At rest, normal muscle does not show any electrical activity. Denervated muscle: Fibrillation potentials appear within 1421 days after denervation. Earliest signs of recovery: Reinnervation potentials can be seen much before (up to 12 weeks) any visible facial movement. Limitation: It cannot assess the degree of degeneration or prognosis for recovery.
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Central Nervous System Drugs 125 Side effects: are similar to worldwide depression definition buy discount zyban online those of chlorpromazine; it is claimed to anxiety 7 weeks pregnant order zyban canada have a lower tendency to jammerdepression definition generic 150mg zyban free shipping induce extrapypramidal symptoms than the classic neuroleptics, although extrapypramidal phenomena, tardive dyskinesia and the neuroleptic malignant syndrome have all been reported. Dose and Administration: Oral: Adult: 2 mg/day on the 1st day, 4 mg/day on the 2nd day, 6 mg/day on the 3rd day; then individualised if necessary. Doses > 10 mg/day do not appear to produce increased efficacy, and may cause increased side effects. Elderly (or in renal or hepatic impairment): initially 1 mg/day, increased by 1 mg/day up to 2 - 4 mg/day. Thioridazine Hydrochloride Tablet, 10mg, 25mg, 100mg Indications: under specialist supervision, second line treatment of schizophrenia in adults (see notes above). Drug interactions: antiepileptics (except carbamazepine), barbiturates, antihypertensives and B-blockers, anticoagulants; anaesthetics, analgesics, antiarrhythmics, antibacterials, antidepressants, antifungals, antihistamines, antimalarials, other antipsychotics, antivirals, diuretics, litium, pentamidine isetionate, sibutramine Contraindications: Thioridazine is contraindicated in patients with: Clinically significant cardiac disorders. Dose and Administration: Oral: Adult: 50 300 mg daily (initially in divided doses): Max. Central Nervous System Drugs Trifluoperazine hydrochloride Tablets, 1 mg, 5 mg Capsules, 2 mg, 10 mg Syrup, 1 mg/5 ml Injection, 1 mg/ml; 2 mg/ml Indications: treatment of schizophrenia and for management of psychotic disorders. Drug interactions: aminoglutethimide, carbamazepine, nevirapine, phenobarbital, phenytoin, azole antifungals, ciprofloxacin, clarithromycin, diclofenac, doxycycline, isoniazid and protease inhibitors. Side effects: hypotension, cardiac arrest, extrapyramidal symptoms, dizziness, headache, constipation, stomach pain, vomiting, hepatotoxicity, dizziness, and headache. Dose and Administration: Psychoses: Adult: Oral: initially 5 mg twice daily or 10 mg daily in modified - release form, increased by 5 mg after 1 week, then at intervals of 3 days, according to the response; I. M: 1- 2 mg every 4-6 hours as needed up to 10 mg/24 hours maximum; for elderly 1 mg every 4 - 6 hours; increase at 1 mg increments; do not exceed 6 mg/day. Child up to 12 years: Oral: initially up to 5 mg daily in divided doses, adjusted according to response, age, and body weight. Short term adjunctive management of severe anxiety: Oral: Adult: 2 - 4 mg daily in divided doses or 2 - 4 mg daily in modified-release form, increased if necessary to 6 mg daily; Child 3 - 5 years, up to 1 mg daily, 6 - 12 years, up to 4 mg daily. Central Nervous System Drugs 127 depression associated with psychomotor and physiological changes such as loss of appetite and sleep disturbances; improvement in sleep is usually the first benefit of therapy. Since there may be an interval of 2 weeks before the antidepressant action takes place electroconvulsive treatment may be required in severe depression when delay is hazardous or intolerable. Some tricyclic antidepressants are also effective in the management of panic disorder. Tricyclic and related antidepressant drugs can be roughly divided in to those with additional sedative properties and those, which are less so. Agitated and anxious patients tend to respond best to this drug because of its additional sedative property. Though amitriptyline can be sedating, it is not recommended for use purely as a sedative - hypnotic, as other agents have greater efficacy with fewer adverse effects. Duloxetine weakly inhibits dopamine re-uptake with no significant affinity for histaminergic, dopaminergic, cholinergic or adrenergic receptors. Central Nervous System Drugs Contraindications: recent myocardial infarction, arrhythmias (particularly heart block), not indicated in manic phase, severe liver disease. Side effects: dry mouth, sedation, blurred vision (disturbance of accommodation, increased intraocular pressure), constipation, nausea, difficulty with micturation; cardiovascular. Dose and Administration: Oral: 3-4 tablets in divided doses; this may be increased to 6 tablets/day as required; some patients respond to smaller doses and can be maintained on 2 tablets. Clomipramine Hydrochloride Capsules, 10mg, 25mg, 50mg Indications: phobic and obsessional states, panic attacks. Cautions: cardiac disease, history of epilepsy, pregnancy, breastfeeding, elderly, hepatic impairment, thyroid disease, phaeochromocytoma, history of mania, psychoses, angle- closure glaucoma, history of urinary retention, concurrent electroconvulsive therapy, avoid abrupt withdrawal, anaesthesia. Drug interactions: alcohol, artemether + Lumefantrine, carbamazepin, chlorpromazine, epinephrine, ethosuximide, fluphenazine, haloperidol, phenobarbital, phenytoin, procainamide, quinidine, ritonavir, valproic acid. Central Nervous System Drugs 129 Contraindications: recent myocardial infarction, arrhythmias (especially heart block); manic phase in bipolar disorders, severe liver disease; children, porphyria. Dose and Administration: Oral: Adult: initially 50 - 75mg/day, increased gradually to 150 mg/day if necessary. Obsessive-Compulsive disorder: Dosage may have to be increased beyond those generally used. Child: initially 10/mg/day, increased gradually to 20mg for 5-7 years old, and to 20 - 50 mg for 8 - 14 year olds. Nocturnal enuresis (adjunctive therapy) in children over 6 years of age, after exclusion of organic pathology; adjuvant to pain relief in chronic pain syndromes, also drug management of panic disorders. Cautions: hyperthyroidism (or on thyroxin therapy), arrhythmias, epilepsy, prostatic enlargement, closed-angle glaucoma or impaired liver function. Side effects: dry mouth, blurred vision, constipation, and difficulty with micturition. Blood pressure changes, syncope, tachycardia, arrhythmias, precipitation of epileptic seizures, sedation, excessive sweating, muscle tremors, restlessness, weakness, interference with sexual function and confusional states, especially in the elderly, extrapyramidal symptoms, allergic skin reactions and, rarely, cholestatic jaundice and blood disorders, including agranulocytosis. Dose and Administration: Oral: Adult: Depression: initial: 25mg 3-4 times/day, increase dose gradually, total dose may be given at bedtime; maximum: 300mg/day. Central Nervous System Drugs Elderly: initially 10-25mg at bedtime; increasing up to 100mg/day as required and if tolerated. Child: Nocturnal enuresis: 6 - 7 years, 10 - 25mg; 8 - 11 years, 25 - 50mg; > 11 years, 25 - 75mg; given as a single dose after the evening meal. Cautions: previous seizure disorder, monitor worsening of depression or suicidality. Carbamazepine, phenytoin, rifampin, nevirapine, phenoarbital, phenytoin and rifamycins. Side effects: headache, somnolence, insomnia, nausea, chest pain, hypertension, palpitation, dizziness, fatigue, dreaming anormal, concentration impaired, fever, irritability, lethargy, lightheadedness, migraine, vertigo, yawning, rash, hot flashes, libido decreased, anorgasmia, menstrual cramps, menstrual disorder,diarrhea, xerostomia, appetite decreased, constipation, indigestion, abdominal pain, abdominal cramps, appetite increased, flatulence, hearturn, toothache, vomiting, weight gain/loss, impotence, urinary tract infection, blurred vision, sinusitis, cough. Skin rashes have been reported and may be a warning of a serious systemic reaction, possibly related to vasculitis. Decreased libido and sexual dysfunction, weight loss, asthenia, hypoglycemia, 132 4. Fluvoxamine maleate Tablets, 40 mg, 100 mg Indications: Major depressive disorders, especially where sedation is undesirable; panic disorder; obsessive-compulsive disorder, social phobia. Side effects: nausea, somnolence, sweating, tremor, dry mouth, asthenia, insomnia, constipation, dizziness, sexual dysfunction, dyspepsia, vomiting, diarrhea, anxiety, decreased appetite and headache. Extrapyramidal effects have been reported, also skin rashes, bruising and elevations of hepatic enzymes, with isolated reports of serious liver function abnormalities. Hyponatraemia has been reported, especially in the elderly, Dose and Administration: Oral: Adult: Depression: initially 100mg daily as a single dose in the evening, increased if necessary; usual range 100 - 200 mg/day; maximum 300mg/day. Maximum: 8-12 years: 200mg/day, adolescents: 300mg/day; lower doses may be effective in female versus male patients. Central Nervous System Drugs 133 Indications, Cautions, Drug interactions and Side effects; see under fluvoxamine. Dose and Administration: Oral: Adult: Depression: initially 50mg daily, usual range 50 - 100 mg/day. May be increased, if necessary, by increments of 50mg over several weeks up to a maximum of 200 mg/day.
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Common/vernacular names: Chinese jujube depression symptoms fever zyban 150mg with visa, red date mood disorder related to pms buy discount zyban 150mg, black date chapter 8 mood disorder order zyban, jujube plum, da zao, hong zao, hei zao, and zao. Produced throughout China, with major production in the northern and central provinces. Several types of jujube are produced, depending on the process used; the red type (red date) is the most commonly available in the United States. Other constituents include plant acids (malic, tartaric), sterols, coumarins, flavonoids (kaempferol, myricetin), triterpenes and triterpenic glycosides (oleanolic acid; oleanonic acid; ursolic acid; maslinic acid; betulin; betulinic acid; betulonic acid; ziziphin, zizyphus saponins; jujubasaponins, jujuboside B, and so on), isoquinoline alkaloids (stepharine, asimilobine, N-nor-nuciferine, etc. Extracts used as an ingredient in herbal tonic formulas in capsule, tablet, or liquid form; crude used in soup mixes. Da zao is one of the major Chinese qi (chi, energy) tonics whose Juniper berries 389 recorded use dates back to the Shan Hai Jing (ca. It is a common food, normally eaten in candied form or in soups, often in winter, to normalize dry skin and to relieve itching. Traditionally regarded as sweet tasting and warming, invigorating vital energy (bu qi), promoting the secretion of body fluids (sheng jin), regulating body nutritional balance and defense (tiao he ying wei), tonifying blood and tranquilizing, and neutralizing drug toxicities. Traditionally used in treating lack of appetite, fatigue, and diarrhea due to spleen deficiency; hysteria; also more recently in treating anemia, hypertension, and purpura. In Arab system of medicine, common jujube is used in treating fever, wounds and ulcers, inflammatory conditions, asthma, and eye diseases, and as a blood purifier. Due to its high content of sugar and other nutrients, common jujube is prone to mold and insect attack if not treated and stored properly. One effective method is to store it in a wood container in an airy place mixed with black ashes of rice husks. Part used is the dried, mature female cone, which is 390 Juniper berries generally called ``berry' because of its berrylike appearance. An essential oil is obtained by steam distillation of the crushed, dried, partially dried, or fermented berries; the essential oil produced from unfermented berries is considered to be superior in flavor qualities. Major producing countries include Italy, Hungary, France, Austria, Czech Republic, Slovakia, Germany, Poland, Russia, and Spain. Berries collected in northern Italy, Hungary, France, Austria, and the Czech Republic are considered superior in quality than those collected in other regions. Antimicrobial activity of the essential oil shas been reported against many fungal (yeasts and dermatophytes) and bacterial strains. The activity was attributed to cryptojaponol, b-sitosterol, and unsaturated fatty acids. Berries and extracts are used as components in certain diuretic and laxative preparations. Juniper berry oil is generally considered to have diuretic properties; it also has Juniper berries 391 Food. Berries are widely used as a flavor component in gin and also in alcoholic bitters. Extracts and oils are used in most major food categories, including alcoholic and nonalcoholic beverages, frozen dairy desserts, candy, baked goods, gelatins and puddings, and meat and meat products. Used as a carminative and diuretic; to treat flatulence, colic, snakebite, intestinal worms, and gastrointestinal infections; vapor (with steam) used in bronchitis. Strengths (see glossary) of extracts are expressed in flavor intensities or in weight-to-weight ratios. Subject of a German therapeutic monograph; dried berries at a daily dosage of 210 g, calculated to 20100 mg of essential oil, allowed for dyspeptic complaints. Karaya gum is collected by blazing or charring the tree trunk and removing a piece of bark or by drilling a hole into the trunk. The gum exudes from the wound and solidifies to form large tears or worm-like strips. After being collected, the tears and strips are broken up and the fragments are graded based on color and amount of adhering bark. Food-grade karaya gum is produced from the crude gum fragments by a series of physical processes whereby most of the impurities (especially bark, wood, and soil) are removed and the gum is ground, sized, and blended to yield uniform grades of gum containing no more than 3% of water-insoluble impurities. Food-grade karaya gum is usually a white to pinkish gray powder with a slightly vinegary odor and taste. The better grades are white and contain less insoluble impurities than the lower grades. Gum karaya is the least soluble of the commercial plant exudates, but it absorbs water rapidly and swells to form viscous colloidal solutions (sols) or dispersions at low concentrations. Higher concentrations (up to 4%) when hydrated in cold water will produce a viscous gel-like paste. The powdered gum behaves similarly on storage, especially under hot and humid conditions. Unlike other plant gums, karaya gum swells in 60% alcohol, but it is insoluble in organic solvents as the other gums. Gum karaya is generally compatible with proteins, carbohydrates, and other plant gums. The polysaccharide of karaya gum has been reported to have a high molecular weight (9,500,000). Available data have indicated that the complex polysaccharide contains at least three different types of chains. It has been postulated that one chain (constituting 50% of the total polysaccharide) contains repeating units of four galacturonic acid residues containing b-D-galactose branches and an L-rhamnose residue at the reducing end of the unit. A second chain (17% of the polysaccharide) contains an oligorhamnan having D-galacturonic acid branch residues and interrupted occasionally by a D-galactose residue; galacturonic acid was present in 50%, rhamnose 40%, and galactose 10% by weight. It is used extensively as a water binder to prevent water separation or formation of ice crystals in sherbets, ice pops, and cheese spreads; as a stabilizer in French dressing, meringues, whipped cream, and toppings; and as a binder in meat products. It has laxative activities, due to the ability of its granules to absorb water and swell up to 100 times their original volume, forming a discontinuous type of mucilage. Use of the gum as an aphrodisiac in Arabic tradition lacks experimental conformation. In its larger particle size (830 mesh), karaya gum is used extensively as a bulk laxative in laxative preparations. Its fine powder is used in dentistry as a dental adhesive and in related preparations. Also used as a thickener and suspending agent in lotions, creams, and hair-setting preparations. Kavalactones contained in the resin are apyrones bearing a methoxyl group at C-4 and an aromatic styryl moiety at C-6. They include kavain, 7,8-dihydrokavain, 5,6-dehydrokavain, yangonin, 5,6,7,8-tetrahydroyangonin, methysticin, dihydromethysticin, 5,6-dehydromethy sticin, 5,6-dihydroyangonin, 7,8-dihydroyangonin, 10-methoxy-yangonin, 11-methoxy-yangonin, 11-hydroxy-yangonin, hydroxykavain, and 11-methoxy-l2-hydroxy-dehydrokavain, and 11methoxy-5,6-dihydroyangonin. Local anesthesia is produced in the mouth in mastication of fresh kava, especially by kavain. However, subcutaneous injections of an alcoholic extract of kavain produces anesthesia for several hours (or days) but can cause paralysis of peripheral nerves; therefore, it is an unsuitable local anesthetic drug.
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This is true depression youth symptoms buy zyban 150mg cheap, because most of them are coming from the western countries and from Suadia Arabia depression yoga discount zyban 150 mg on line, and these countries have higher levels of income depression symptoms brain fog purchase generic zyban online. Based on these results, visitors to Jordan spas are rich and can afford to pay for the services. Expenses include costs of treatment, accommodation, food and beverage, transportation inside Jordan, entertainment, etc. Here, the majority of the tourists (61 %) spend between 20 and 100, but again this is not accurate, because Jordanians are included. This is true due to the fact that most of the sample was Jordanians and from the neighboring countries. This has resulted from a poor public transport network, which the curative sites are missing. This agrees with the definition of some researcher that other people who come with the tourist (patient) as companions should be included in the concept of curative tourism, in order to have real facts and statistics about the sector (Magablih: 2001). Those who come with the patient spend money and they can be potential customers in the future after they have tried the curative waters. It could be effective if it based on real marketing channels of distribution first, but the case here is different in that out of 116 who answered "relatives and friends", 100 were Jordanians, Saudis, Palestinians or Egyptians. This is true for those who come from Germany and Austria, where they get paid for the costs totally or partially. The rest of the channels or means of promotion got less attention, tour operators got 5 %, broadcast media 3 % and internet, which became more famous and attractive in modern marketing, got only 1 %. Therefore, the author has chosen only two alternatives (treatment or relaxation and entertainment). Most curative tourist use Jordan curative waters for the purpose of treatment from one or more body ailment (71 %), the rest was relaxation and entertainment. The majority of patients suffer from psoriasis (27 %), where it is the most common skin disease that affects 2-3 % of the world population. The second disease group is problems of the joint (arthritis, ankylosis and rheumatism), which they allocated for 39 % of the sample. Statistics in Jordan are more or less similar to those of Sweden, but there is no official statistics. Asthma has a fair percentage of 7 % and the rest of the diseases account for 27 %. Skin allergy, blood pressure, vitiligo, degenerative disc, knee problems, neurodermatisis and eczema, are of the other types of diseases that the patients suffer from. The rest uses other types such as creams, massage, fitness, herbal baths and a like (3 %). On the other hand, services (6, 10-17 and 20) fall under the mean of the instrument, and then the visitors were not satisfied with these services. This implies that Jordan should invest in its infra and superstructures to accommodate and satisfy the needs of tourists. Sex, nationality, length of stay and to some degree profession have differences of statistical significance in evaluation of services in that the significance degree is 5%. Marital status has no differences of statistical significance except for treatment prices. Generally speaking, age has no differences that have statistical significance, but some services have significance differences in evaluation. These include treatment prices; prices of food and beverage; prices and quality of accommodation; efficiency of therapists; toilets and showers; drinking water; transportation; treatment equipments; parking; communication facilities; children playing facilities and paying with credit cards services. The second hypothesis is about the length of stay, and then the following hypothesis is tested: 5. The rest stayed less than 1 day (a day visit) with 34 % and the majority of them were Jordanians, and only 1% stay between 6-10 days. However, the average length of stay for other types of tourism in Jordan is 4 days130; then, curative tourists stay more than other types of tourist. The third hypothesis deals with the mean of knowledge about the curative sites in Jordan. The majority of tourists did get know about Jordan spas through friends and relatives (55%). Despite the fact that this means that Jordan spas are well known, especially within the region, but this means, also, that other modern methods of marketing and promotion are not adopted enough. An interesting number of tourist come to know about Jordan spas through their doctor or through the Insurance Funds in their countries (24%), where Jordan is cheaper than any other destinations in the region with acceptable services. The fourth hypothesis is dealing with the evaluation of visitors towards the services they get during their stay. These include food and beverage prices; efficiency of therapists; cleanliness; toilets and showers; drinking water; public transportation; availability of information about curative sites; parking and children facilities. This means also the services that got low evaluation should be enhanced and upgraded in order to build a positive image of Jordan spas. There are differences that have statistical significance exist between the services and demographic factors such as sex, nationality, and length of stay and to some degree profession. This can be said to the fact that the western tourists were used to higher standards of services at their countries, and then they are not satisfied with the services that rendered to them in Jordan spas, because they expected more than what they got. Other factors such as marital status and age, generally, there are no differences existed between the sites except for some services such as prices; quality of accommodation and food and beverage; transportation; communication facilities toilets and showers; drinking water; parking; children playing facilities and paying with credit cards. As a result, the Null hypothesis (H0) is rejected and the alternative hypothesis is accepted, which implies differences that existed between sites on evaluation of services according to some demographic and economic factors. Jordan enjoys natural curative resources, which are rare elsewhere, and have higher qualities due to its distinctive climate, but they lack many services, efficient infra and superstructures, qualified human resources, effective marketing and promotion. The majority of visitors to Jordan spas were men, who have the age group of 50+, married, have income level between 1000 and 2999 and spend 61100. Most of the visitors live in hotels, chalets or furnished apartments in or near the curative sites. The length of stay for curative tourists in Jordan is between 3 to 4 weeks, which is higher than of any other type of tourism. Curative tourists evaluate the service rendered to them at Jordan curative spas positively, except for some services such as prices of accommodation, food and beverage or treatment, quality of food, accommodation, transportation, efficiency of therapists. There exist differences of evaluation by tourists between curative sites, which have statistical significance according to factors of sex, nationality and length of stay. Psoriasis and problems of the joint, such as arthritis, ankylosis and rheumatism are of the major diseases that are healed in Jordan curative waters. The research revealed that 20 curative sites in Jordan have been identified and classified according to technical and economic feasibility for potential development. The author found that 4 sites are classified as of high potential development, 10 of medium potential and 6 have low potential for development (Appendix 2). The tourist bodies in Jordan lack a clear vision and tourism strategies concerning curative tourism. They mean medical tourism (hospitals and medical centres) when they are talking about health tourism.