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Running Header: ELEMENTS OF CAM: SYLLABUS, NOTES, HANDOUTS 1

ELEMENTS OF CAM AS DE-STRESSORS

TABLE OF CONTENTS

I. Instructor InformationII. Course InformationIII. Course ObjectiveIV. Course Overview V. Course Lecture NotesVI. Student HandoutsVII. Course Resource ListVIII. Project Reference

INSTRUCTOR INFORMATION

Instructor Name and Credentials: Karla Petersen, CSEP-CEP, R.D.

Prince George’s Community College Email Address: [email protected]

COURSE INFORMATION

Term: Summer Supplementary Course

Dates and Times: Saturdays, June 2nd, June 9th, and June 16th 2012; 10:30 a.m. - 12 Noon

Course Number/Section: HE370 - 01

Course Title: Elements of CAM as De-Stressors

Credit Hours: 2

Prerequisites: Elements of CAM

COURSE OBJECTIVE

Through lectures and guided contemplative interactive lessons, this course aims to teach students how to integrate the elements of CAM into their daily lives in order to aid in the alleviation or eradication of stressors.

COURSE OVERVIEW

Welcome to Elements of Complementary Alternative Medicine, HE370, or Elements of CAM, an introductory course designed to present the wide variety of non-allopathic, or non-traditional, medical practices used for generations for disease management and prevention. This section, HE370 – 01, Elements of CAM as De-Stressors, teaches the student how to integrate the elements of CAM into their lives in order to deal with stress effectively. This goal is accomplished by going beyond the lecture and hosting carefully chosen contemplative exercises to teach students how to perform on their own in order

ELEMENTS OF CAM: SYLLABUS, LECTURE NOTES, STUDENT HANDOUTS 2

to effectively alleviate or eradicate the stressors in their everyday lives. (COURSE DISCLAIMER: As some activities performed in this course require physical involvement, it is recommended that all students inform and clear with primary care physician prior to registration).

This is an Aetna-funded course, therefore all information can be found on their Web site listed in the Resources section of the Student Handout Section.

Wk # and Topic Course Lectures Learning Activities

Week #1 –CAM as a De-Stressor Intro

What Stresses You Out?What is NCCAM?What is CAM?How is CAM a De- Stressor?

An Exercise in Deep,

Diaphragmatic Breathing

Homework: A Contemplative

MealWeek #2 – CAM and Your Body

Exercise – De-stress with MovementQuote and ChartDiet - De-stress with NutritionDetoxification Rest

Empowering Stretches

Week #3 – CAM and Your Mind

Contemplative ExercisesPrayerMeditationDeep BreathingSounds: Soothing Music, Sounds of Nature, “White” Noise (soundtracks of rain, etc.)Rest Certificates

A Contemplative Interaction: “Tea at the

Shores"

COURSE LECTURE NOTES

Week #1 – Stress and CAM Overview

- What Stresses You Out? Life’s Challenges and Pressures relationships, money, health issues, people, deadlines, traffic, the news?


Please answer: What can you control? What can you not control?

There is normalcy to stress: survival; the “fight or flight” response is necessary to get us as far away from danger as possible. Stress hormones deplete once all signs of danger are gone, as the “body’s physiological response mechanisms are superbly adapted for dealing with such short-term physical emergencies.” (Sapolsky, 1998, p. 6). However, when they remain, lingering stress hormones exact physical damage, which is why perpetual stress, always being stressed, takes a physical toll on the body; it is the continual presence of blood stress hormones . This toll is articulated as “heart disease, anxiety disorders, high blood pressure, coronary artery disease, cancer, respiratory disorders, accidental injuries, cirrhosis of the liver, and attempted suicide, all of which are leading causes of death in the United States.” (Keegan, 2003).

You are not here, however, to learn how to counter the effects of stress on the body – and what does CAM have to do with it? How can CAM de-stress?

CAM is effective as a de-stressor because, as a collection of therapies employed to serve the person in all aspects of humanity: spirit, body, and mind, there exists the increased possibility of being able to treat the individual holistically, many times with no side effects.

In the words of Elliott Dacher, medical doctor turned holistic healer and author of Integral Healing: The Path to Human Flourishing,“The key to the next quantum leap in health and healing will emerge from the development of our inner life and our consciousness… to integrate the methods and practices…we must be willing to refocus our energy, attention, and efforts on exploring the still uncharted frontier of the human mind and its healing capacities.” (Dacher, 2006, p. 15).

The mind-body connection is critical to healing and well-being: it is never enough to just treat the body, the mind must also be treated, hence, the integration of CAM as lifestyle responses to prevention and management of illness and disease.

- What is CAM?

Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor. (National Center for Complementary and Alternative Medicine, 2007)

- The National Center for Complementary and Alternative Medicine,

or NCCAM, a component of the National Institutes of Health, is the Federal Government's lead agency for scientific research on CAM.


- NCCAM's mission is to explore complementary and alternative healing practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals.

- NCCAM groups CAM practices into four domains, recognizing there can be some overlap. In addition, NCCAM studies CAM whole medical systems, which cut across all domains. (Ibid).

Whole Medical Systems

Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include Traditional Chinese medicine and Ayurveda.

Mind-Body Medicine

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically Based Practices

Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

Manipulative and Body-Based Practices

Manipulative and body-based practices in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.


Energy Medicine

Energy therapies involve the use of energy fields. They are of two types:

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include Qi gong, Reiki, and Therapeutic Touch.

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

- How Can You De-Stress with CAM? - There are many CAM techniques that can be applied to lowering the

stress(es) in, or de-stressing, your life. Some are: - Deep-Breathing (Mind-Body Medicine)- Deep Tissue Massages (Manipulative & Body-Based)- Meditation/Prayer (Mind-Body Medicine)- Talking (Mind-Body Medicine)- Listening to “White Noises,” e.g., the ocean, rain, wind (Mind-

Body Medicine)- Painting/Sculpting/Quilting/Cooking (Mind-Body Medicine)- Dancing (Mind-Body Medicine)- Exercising

“Increasingly, CAM therapies are being integrated with conventional medicine. According to the American Hospital Association's Annual Survey of Hospitals, the percentage of hospitals offering CAM has increased from 7.9 percent in 1998 to 19.8 percent in 2006 (Ananth 2009; Henkel 2010). The widespread and growing consumer demand for CAM in the U.S. led Wyatt and Post-White (2005) to write that conventional “health care must now catch up with consumer practices to provide guidance in the safe and effective use” of CAM.” (Pamela Jo Johnson, 2012).

“In recent years, integrative medical-research clinics have been springing up all around the country, 42 of them at major academic medical institutions including Harvard, Yale, Duke, the University of California at San Francisco, and the Mayo Clinic. Most appear to be backed enthusiastically by administrators and many physicians.” (Freedman, The Triumph of New-AgeMedicine, 2011)


CAM is a reminder that we are more than health challenges, issues, medical or clinical conditions, etc., but people experiencing them; CAM keeps us in touch with ourselves, which, I believe, lends itself to arriving at healing more quickly than depending solely on pharmaceuticals alone. Our minds MUSAT be involved in our healing Homework assignment: Follow the following instructions for cooking a meal from scratch. You may eat alone, or with someone else, but plan to take the time to cook the meal and to journal your feelings before, during, and after the meal. Be prepared to share your thoughts next class.

Week #1 – (Last 10 mins. Of Class) Interactive Learning Activity: Guided Deep-Breathing

Please Fill in the Week #1 Student Interactive Learning Activity. Thank you!

Week #2 – CAM and Your Body

- Physical Activity – De-stress with Exercise, Dance, Stretching, Yoga, Tai Chi; Howley and Franks quote: “Total Fitness;” CDC Age/Activity Chart

- Diet – De-stress with Nutrition; eating healthy, nutrient-dense, colorful foods; Schlenker quote

- Visualization/Mental Imagery/Self-Talk – De-Stress with Confident, Esteem-feeding Self-Talk: “I am calm;” “I can do this!” “I have value;” “I am strong.” “I am healthy;” “I am beautiful!” and seeing yourself as each of these

- Detox/Fasting – De-Stress through cleansing or missing a meal or meals- Rest – De-Stress by getting necessary sleep, by doing nothing

Week #2 – (Last 10 mins. Of Class) Interactive Learning Activity: Empowering Stretches


Week #3 – CAM and Your Mind

- Contemplative Exercises: e.g., Dr. Elliott Dacher’s contemplative CDs- Prayer- Meditation- Deep Breathing- Visualization/Mental Imagery/Self-Talk – De-Stress with Confident, Esteem-

feeding Self-Talk: “I am calm;” “I can do this!” “I have value;” “I am strong.” “I am healthy;” “I am beautiful!” and seeing yourself as each of these (this is a mind-body activity; the body follows the mind)

- Sounds: Soothing Music, Sounds of Nature, “White” Noise (rain, etc.)- Rest - Certificates


Week #3 – (Last 20 mins. Of Class) Interactive Learning Activity: “Tea Leaves” by the Shore:” (the combination of deep-breathing while sipping a simple blend of thyme leaves and honey tea while listening to a soundtrack of the rain showers with lavender aromatherapy).


STUDENT HANDOUTS (3)

1. COURSE OUTLINE FOR ELEMENTS OF CAM AS DE-STRESSORS

Introduction: We cannot always control the situations and circumstances of life, but we can control how we respond to them. The ambitious goal of this course is to empower to alleviate or eradicate the stressors in your life through the application of CAM information to enable you to make informed choices in dealing with the stressors in your daily life.

You are here because you are currently using and/or participating in some form of CAM, are skeptical and willing to learn, or merely curious and looking for answers. This course is for all of you!

I. Week #1 - Stress and CAM Overview

A. What Stresses You Out?

1. Life’s Challenges and Pressures

a. what you cannot control

b. what you can control

B. What is CAM?

C. CAM as a De-Stressor

“Increasingly, CAM therapies are being integrated with conventional medicine. According to the American Hospital Association's Annual Survey of Hospitals, the percentage of hospitals offering CAM has increased from 7.9 percent in 1998 to 19.8 percent in 2006 (Ananth 2009; Henkel 2010). The widespread and growing consumer demand for CAM in the U.S. led Wyatt and Post-White (2005) to write that conventional “health care must now catch up with consumer practices to provide guidance in the safe and effective use” of CAM.” (Pamela Jo Johnson, 2012).

Homework: Follow the following instructions for cooking a meal from scratch. You may eat alone, or with someone else, but take the time to journal your feelings before, during, and after the meal,

A Contemplative Meal: Veggie Stir-Fry: ½ each green, red, and yellow bell peppers, broccoli, zucchini, baby spinach, red onions, oregano, parsley,


and fresh green onions. Wash all ingredient items thoroughly, resting briefly in paper towel to remove excess water. Heat 1 tbsp. olive oil, adding all ingredients, stirring constantly around the skillet with a wooden spoon until cooked and crispy. Serve immediately. Eat at a table, pausing to give thanks for your meal. Breathe deeply. Take your time to interact with your food: look at your food on the plate, take in all the colors, the scents, the warmth of the just-cooked food, pick up your fork and begin eating. Chew slowly: taste the foods, feel the textures, continue chewing slowly, taking time to break food down before swallowing. Swallow. Feel the food go down your esophagus. Pause. Close your eyes, breathing deeply. You have just fed and nourished your body, spirit, and your mind. Repeat the process.

II. Week #2 - CAM and Your Body

A. Exercise – De-stress with Movement

B. Howley and Franks Quote

1. “High fitness in one area enhances the other areas, and conversely, lower fitness in any area restricts the accomplishments possible in other areas…physical activity plays a major role in the physical dimension, it also contributes to learning, relationships, and a sense of our [humanity in the larger scheme of life.] An optimal quality of life requires individuals to strive, grow, and develop, though they may never achieve the highest level of fitness. The totally fit person nevertheless continually strives for the highest quality of life possible. ” (Howley, 2007, p. 6).

C. The Centers for Disease Control, or CDC Recommendations:

Age Group, yrs. Aerobic Muscle Strengthening6 – 17 1hr+/daily 3 Xs wkly

18 – 64 2:30 hrs./wkly 2 hrs. +/wk65 – 2:30 hrs./wkly 2 hrs. +/wk

D. Detoxification1. A necessity, not a fad;


2. be educated; seek guidance3. The body naturally detoxes itself; however, poor diet and sedentary lifestyle

creates toxic physiological environment4. Cleanses body of toxic build-up5. Restores homeostasis

6. Promotes healing, systemically calming

III. Week #3 – CAM and Your Mind

A. Elliott S. Dacher Quote

1. We Can Train the Minda. “The key to the next quantum leap in health and healing will emerge from

the development of our inner life and our consciousness… to integrate the methods and practices…we must be willing to refocus our energy, attention, and efforts on exploring the still uncharted frontier of the human mind and its healing capacities.” (Dacher, 2006).

2. Contemplative Exercisesa. Contemplative Exercisesb. Prayerc. Meditationd. Deep- Breathing e. Sounds: Soothing Music, Sounds of Nature, “White” Noise (rain, etc.)f. Rest

B. Diet - De-stress with Nutrition1. “Sound nutrition principles along with skills in food selection are the

cornerstone for personal health…” (Schlenker & Long, 2007, p. 3)2. HOMEWORK: A Home-Cooked Meal

a. does not have to be fancy, but must be nutrient-dense food. C. Rest

D. Presentations of Certificates

2. CAM DEFINITIONS

Acupuncture ("AK-yoo-pungk-cher") is a method of healing developed in China at least 2,000 years ago. Today, acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.


Aromatherapy ("ah-roam-uh-THER-ah-py") involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote health and well-being.

Ayurveda ("ah-yur-VAY-dah") is a CAM whole medical system that has been practiced primarily in the Indian subcontinent for 5,000 years. Ayurveda includes diet and herbal remedies and emphasizes the use of body, mind, and spirit in disease prevention and treatment.

Chiropractic ("kie-roh-PRAC-tic") is a CAM whole medical system. It focuses on the relationship between bodily structure (primarily that of the spine) and function, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool.

Dietary supplements. Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product (other than tobacco) taken by mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites. Dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps, liquids, and powders. They have special requirements for labeling. Under DSHEA, dietary supplements are considered foods, not drugs.

Electromagnetic fields (EMFs, also called electric and magnetic fields) are invisible lines of force that surround all electrical devices. The Earth also produces EMFs; electric fields are produced when there is thunderstorm activity, and magnetic fields are believed to be produced by electric currents flowing at the Earth's core.

Homeopathic ("home-ee-oh-PATH-ic") medicine is a CAM whole medical system. In homeopathic medicine, there is a belief that "like cures like," meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms.

Massage ("muh-SAHJ") therapists manipulate muscle and connective tissue to enhance function of those tissues and promote relaxation and well-being.

Naturopathic ("nay-chur-o-PATH-ic") medicine, or naturopathy, is a CAM whole medical system. Naturopathic medicine proposes that there is a healing power in the body that establishes, maintains, and restores health. Practitioners work with the patient with a goal of supporting this power, through treatments such as nutrition and lifestyle counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese medicine. Osteopathic ("ahs-tee-oh-PATH-ic") medicine is a form of conventional medicine that, in part, emphasizes diseases arising in the musculoskeletal system. There is an underlying belief that all of the body's systems work together, and disturbances in one system may affect function elsewhere in the body. Some osteopathic physicians practice osteopathic manipulation, a full-


body system of hands-on techniques to alleviate pain, restore function, and promote health and well-being.

Qi gong ("chee-GUNG") is a component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function.

Reiki ("RAY-kee") is a Japanese word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient's spirit is healed, which in turn heals the physical body.

Therapeutic Touch is derived from an ancient technique called laying-on of hands. It is based on the premise that it is the healing force of the therapist that affects the patient's recovery; healing is promoted when the body's energies are in balance; and, by passing their hands over the patient, healers can identify energy imbalances.

Traditional Chinese medicine (TCM) is the current name for an ancient system of health care from China. TCM is based on a concept of balanced qi (pronounced "chee"), or vital energy, that is believed to flow throughout the body. Qi is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming imbalanced. Among the components of TCM are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage.

3. Contemplative Journal

Contemplative Journaling

What: Guided Activities Journaling; Thoughts, Feelings

Why: A Reference, a Reminder, Encouragement

Wk #1 Interactive Learning Activity: Guided Deep-Breathing


Wk #2 Interactive Learning Activity: Empowering Stretches

Wk #3 Interactive Learning Activity: “Tea Leaves” by the Shore:” (the

combination of deep-breathing while sipping a simple blend of thyme leaves and honey tea while listening to a soundtrack of the rain showers with lavender aromatherapy).

COURSE RESOURCE LIST

Community Resources

Sports and Learning Complex- a county jewel hosting plethora of physical, community, individual, family, and team activities designed to get individuals moving, healthy, informed, and connected; public pool, indoor track, conference rooms, gymnastics gym, classes, competitive meets, etc.

Watkins Park/Myriad of other Public Facilities – acres of pastoral, tranquil areas to

walk, run, picnic with family and/or friends; large areas to play impromptu; baseball fields, tennis facility (in- and outdoor), seasonal concerts, drive-in style movies, story-telling, hikes, biking, Tai Chi on lawn

Your Backyard/Driveway/Neighborhood – get out and throw the ball around, play handball with yourself or another; play with children; trampoline; gardening; daily walks/runs


Nearby Mall – used as walk courses; alone or with family/friends

Web sites

Aetna –

National Center for Complementary and Alternative Medicine. (2007, April 23). Aetna InteliHealth: Complementary and Alternative Medicine. Retrieved from An Aetna Web site: http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31412/311998.html?d=dmtContent#no1

The Centers for Disease Control and Prevention –

Centers for Disease Control and Prevention. (2011, December 11). Physical Activity for Everyone. Retrieved from A Centers for Disease Control and Prevention Web site: http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

United Department of Agriculture, U. (2010, September 28). MyPyramid.gov-United States Department of Agriculture. Retrieved November 24, 2010, from MyPyramid: http://www.mypyramid.gov/

Harvard –

Harvard School of Public Health. (2011, January 15). Healthy eating Pyramid - What Should You Eat? Retrieved January 15, 2011, from A Harvard School of Public Health Web site: http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/pyramid/

Contemplative Prayer (A Christian Approach) –

Watson, R. A. (2010). Contemplative Prayer. Retrieved from A Secret Place Web site: http://www.secretplaceministries.org/pages/journey/prayer/contemplative-prayer.html

Books

Dacher, E. (2006). Integral Health: The Path to Human Flourishing. Laguna Beach, CA: Basic Health Publications, Inc.

Micozzi, M. S. (2011). Fundamentals of Complementary and Alternative Medicine. St. Louis: Saunders. Retrieved March 5, 2011, from A Kaplan University Web site.

Sapolsky, R. (1998). Why Zebras Don't Get Ulcers. New York, N.Y.: St. Martin's Griffin.

Schlenker, E. D., & Long, S. (2007). Willams' Essentials of Nutrition and Diet Therapy, 9th Ed. St. Louis, MO: Mosby Elsevier.

Schlitz, M. A. (2005). Consciousness and Healing. St. Louis, MO: Elsevier.

http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/pyramid/

http://www.mypyramid.gov/

http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31412/311998.html?d=dmtContent#no1

http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31412/311998.html?d=dmtContent#no1


Thomas Nelson, Inc. (1982). The Open Study Bible: The New King James Version. Nashville: Thomas Nelson, Inc.

Journal Articles

Amie Steel, J. A. (2011). Complementary and Alternative Medicine in Pregnancy: a Systematic Review. Journal of the Australian Traditional-Medicine Society , 205-209.

Freedman, D. H. (2011). The Triumph of New-Age Medicine. The Atlantic Monthly, 90-100.

Keegan, L. (2003). Alternative and Complementary Modalities for Managing Stress and Anxiety. Critical Care Nurse, 55-58.

Pamela Jo Johnson, A. W. (2012). Personal Use of Complementary and AlternativeMedicine (CAM) by U.S. Health CareWorkers. Health Services Research, 211-227.

PROJECT REFERENCES

Amie Steel, J. A. (2011). Complementary and Alternative Medicine in Pregnancy: a Systematic Review. Journal of the Australian Traditional-Medicine Society , 205-209.

Centers for Disease Control and Prevention. (2011, December 11). Physical Activity for Everyone. Retrieved from A Centers for Disease Control and Prevention Web site: http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

Dacher, E. (2006). Integral Health: The Path to Human Flourishing. Laguna Beach, CA: Basic Health Publications, Inc.

Freedman, D. H. (2011). The Triumph of New Age Medicine. The Atlantic Monthly, 90-100.

National Center for Complementary and Alternative Medicine. (2007, April 23). Aetna InteliHealth: Complementary and Alternative Medicine. Retrieved from An Aetna Web site: http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31412/311998.html?d=dmtContent#no1

Pamela Jo Johnson, A. W. (2012). Personal Use of Complementary and AlternativeMedicine (CAM) by U.S. Health CareWorkers. Health Services Research, 211-227.

Schlenker, E. D., & Long, S. (2007). Willams' Essentials of Nutrition and Diet Therapy, 9th Ed. St. Louis, MO: Mosby Elsevier.