Research Publications (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/216

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Dental composite materials: highlighting the problem of wear for posterior restorations
(South African Dental Association, 2007) Le Roux, Andre Rayne; Lachman, Nirusha
Manufacturers of dental composites promote their products as having ideal wear resistant characteristics. Evaluation of the problems that persist with wear of dental composites is made. Recommendations for further research involving wear resistance of dental composite materials are provided. This article provides a review of English, peer-reviewed literature involving wear resistance of dental composite materials conducted through ScienceDirect and hand searched data bases between 1994 and 2006.
Wear and flexural strength comparisons of alumina/feldspar resin infiltrated dental composites
(South African Dental Association, 2008) Le Roux, Andre Rayne; Lachman, Nirusha; Walker, Mark; Botha, T.
Introduction: Incorporating a feldspar chemical bond between alumina filler particles is expected to increase the wear-resistant and flexural strength properties. Aims and Objectives: An investigation was carried out to evaluate the influence of the feldspar chemical bonding between alumina filler particles on wear and flexural strength of experimental alumina/feldspar dental composites. It was hypothesized that wear resistance and flexural strength would be significantly increased with increased feldspar mass. Methods: Alumina was chemically sintered and bonded with 30% and 60% feldspar mass, silanized and infiltrated with UDMA resin to prepare the dental restorative composite material. Results and conclusions: Higher wear-resistant characteristics resulted with increased feldspar mass of up to 60% (p<0.05). Higher flexural strength characteristics resulted as the feldspar mass was increased up to 60% (p>0.05). Feldspar chemical bonding between the alumina particles may improve on the wear-resistance and flexural strength of alumina/ feldspar composites.
Are point-of-decision prompts in a sports science and medicine centre effective in changing the prevalence of stair usage? : a preliminary study
(2009) Pillay, Julian David; Kolbe-Alexander, Tracy; Achmat, Masturah; Carstens, Madelaine; Lambert, Estelle V.
Objective. To determine the impact of a signed intervention on promoting stair versus lift usage in a health and fitness facility. Design. A 3-week observational study in which a simple timeseries design of collecting data before, during and after the introduction of an intervention was used. Setting. The Sports Science Institute of South Africa (SSISA): a 5-storey building with a centrally located lift lobby and internal stairwell. Method. Observers were placed unobtrusively on the ground floor, with good visibility of lift/stairwell, to observe ascending movement of students, staff, tenants, visitors and patients 4 hours/day (07h00 - 09h00, 16h00 - 18h00), 4 days/week for 3 weeks. During week 2, motivational signs were displayed on the wall next to the lift and stairs and on the floor leading to the stairwell. In week 3, signage was removed. Factors considered in predicting stair use were gender, phase of intervention, and whether persons were staff/students or visitors. Results. A total of 4 256 person-counts were recorded. Prevalence of stair use increased from 43% before the intervention to 53% during the intervention to 50% after the intervention. Odds of using the stairs during the intervention increased by 45% (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.25 - 1.68) (p<0.00001), were 41% higher for staff/students compared with visitors (p<0.00001) and were 55% greater for women (p<0.00001). These effects did not change significantly after the intervention and stair use remained modestly higher than before the intervention. Conclusion. Signed intervention produced significant increases in stair usage during and after the intervention. These findings support the effectiveness of point-of-decision prompts for changing behaviour, and highlight potential factors influencing the impact of such messages.
Reducing the alloy thickness of base metal ceramic restorations
(Dental Technicians Association of South Africa, 2009) Le Roux, Andre Rayne
Reduction in base metal alloy thickness will permit additional porcelain depth and improved aesthetics but unfortunately little information exists regarding the thickness to which base metal alloys may be reduced in comparison to noble metal alloys for metal ceramic restorations. Even with comparison of noble metal alloys the aesthetic benefits are restricted to improving aesthetics in base metal restoration further, since noble metal alloys are generally regarded as providing superior aesthetics to base metal restorative alloys. Purpose: The objective of this study was to determine whether a significant reduction in thickness could be achieved using a base metal alloy as compared to a noble metal alloy and the thickness to which base metal alloy substructures could safely be reduced while still providing the same resistance to fracture of the porcelain. Material and methods: Tensile strength tests (N) of the modulus of rupture of the porcelain were performed on 40 base metal alloy (Wiron 99, Bego, Germany) and 12 noble metal alloy rectangular specimens (5.8 mm wide and 15.0 mm long) bonded to a standardized 1.0 mm thickness of dentine Creation porcelain. The base metal alloy thickness varied in 0.1mm increments from 0.1 to 0.4 mm. The results were compared to 12 noble metal alloy (Bio Y 81, Argen, South Africa) specimens of recommended minimum thickness (0.3 mm). Data for the results was obtained using a universal tensile testing instrument, which was set to operate at a cross head speed of 0.5mm (Instron Mini 44, Instron corporation U.S.A). The applied force (N) that measured the modulus of rupture of each specimen was printed from a computer connected to the Instron Mini 44 that operated on a 95% level of confidence. Instron Agents (Durban, South Africa) performed the calibration and setting up of the machine prior to testing the specimens. Results: The results indicated a permissible 33.33% reduction in the base metal alloy specimens as compared to the noble metal alloy control specimens. This was deduced from the reduction in alloy thickness of up to 0.2 mm for base metal alloy specimens as compared to the 0.3 mm noble metal alloy specimens. The recommended thickness to which the base metal alloys could be reduced without distortion of the alloy was also 0.2 mm. The one-way ANOVA showed a level of significance of (α=05).
Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement : a randomized controlled trial of test responsiveness
(Elsevier BV, 2009-09) Lakhani, Ekta; Nook, Brian; Haas, Mitchell; Docrat, Aadil
A tenet of motion palpation theory is the ability to confirm postadjustive segmental end-feel improvement (EFI). Only one previous trial has evaluated the responsiveness of EFI; this was a study of the thoracic spine. The purpose of this study was to evaluate the responsiveness of postadjustive end-feel for evaluating improvement in putative segmental spinal motion restriction after spinal manipulative therapy (SMT) of the cervical spine.
Methods
A prospective, blinded, randomized placebo-controlled pilot trial was conducted with 20 symptomatic and 10 asymptomatic participants recruited from a chiropractic teaching clinic. The treatment group received SMT, and the control group received placebo detuned ultrasound. Responsiveness was evaluated as the etiologic fraction (% of cases with EFI attributable to SMT) and as the sensitivity and specificity of change.
Results
For the entire sample, the etiologic fraction was 63% (P = .002), sensitivity was 93%, and specificity was 67%. For symptomatic participants, a strong relationship appeared to exist between receiving SMT and EFI (etiologic fraction = 78%, P = .006; sensitivity = 90%; specificity = 80%). A strong relationship was not found for asymptomatic participants (etiologic fraction = 40%, P = .444; sensitivity = 100%; specificity = 40%), where EFI was recorded frequently, whether participants received SMT or detuned ultrasound.
Conclusion
The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
Flexibility of experimental alumina/feldspar and SR ADORO dental composites
(South African Dental Association, 2010) Le Roux, Andre Rayne; Lachman, Nirusha
Introduction: Flexure of a dental composite can be detrimental to the success of a restoration. Flexibility considerations are thus important when comparing dental materials to optimize the success of resin restorations. Aims and objectives: Flexibility of 5.6 x 18.0 x 2.0 mm3 experimental alumina/feldspar and SR ADORO® dental composites specimens were compared. It was hypothesized that alumina/ feldspar composites would be less flexible under a load than SR ADORO® composites and that the flexibility would decrease significantly as the feldspar content was increased. Methods: Alumina was chemically sintered or bonded with 40%, 50% and 60% feldspar mass, silanized and infiltrated with urethane dimethacrylate (UDMA) to prepare the alumina/feldspar dental restorative composite specimens. Three point bending tests were performed in the Instron 44® machine for flexural comparison to SR ADORO®. Results and conclusions: The alumina/feldspar specimens showed lower flexibility (mm displacement) than SR ADORO® (p<0.05). Accurate flexibility comparisons were performed with 5.6 x 18.0 x 2.0 mm3 specimens. Flexibility comparisons performed with 5.6 x 18.0 x 2.0 mm3 specimens indicated that experimental alumina/ feldspar dental composites may provide added marginal seal benefit. However confirmation via in vivo function of alumina/ feldspar dental composites is recommended.
Achieving prehospital analgesia
(BMJ, 2010-10-23) Castle, Nicholas; Naidoo, Raveen
GSTM1, GSTP1 and NQO1 polymorphisms and susceptibility to asthma among South African children
(SAJEI, 2012) Reddy, Poovendhree; Naidoo, Rajen N.; Robins, Thomas G.; Mentz, Graciela; Li, Huiling; London, Stephanie J.
Gluthathione-S-transferase (GSTM1 and GSTP1) and nicotinamide quinone oxidoreductase (NQO1) genes play an important role in cellular protection against oxidative stress, which has been linked to asthma pathogenesis. We investigated whether common, functional polymorphisms in GSTM1, GSTP1, and NQO1 influence susceptibility to asthma among schoolchildren in South Africa. Genomic deoxyribonucleic acid (DNA) was extracted from 317 primary schoolchildren, aged 9-11 years, from the urban, underprivileged socio-economic communities of Durban. GSTM1 (null vs. present genotype), GSTP1 (Ile105Val; AA →AG+GG) and the NQO1 (Pro/Ser; CC →CT/TT) genotypes were determined using polymerase chain reaction. Among the children, 30% were GSTM1 null, 65% carried the G allele for GSTP1, and 36% carried the C allele for NQO1.There was a high prevalence of asthma of any severity (46.1%), with 20.4% reporting persistent asthma. The GSTP1 AG+GG polymorphic genotype was significantly associated with persistent asthma (adjusted OR = 3.98; CI = 1.39, 11.36, p-value = 0.01). Neither the GSTM1, nor the NQO1, genotype was a significant predictor of persistent asthma. Therefore, the GSTP1 A/G variant may modulate the risk of persistent asthma among our sample.
Traditional complementary and alternative medicine : knowledge, attitudes and practices of health care workers in HIV and AIDS clinics in Durban hospitals
(African Networks on Ethnomedicines, 2012) Mbutho, Nozuko P.; Gqaleni, Nceba; Korporaal, Charmaine Maria
Traditional complementary and alternative medicine (TCAM) has been reported to be commonly used among individuals with HIV and AIDS disease. However a lack of communication between health care workers (HCWs) and patients as well as between HCWs and TCAM practitioners has been identified as one of the challenges that may adversely affect treatment of HIV and AIDS patients. With improved and sustained communication HCWs, patients and TCAM practitioners would be able to make informed decisions with regards to best treatment practices based on the knowledge of what is safe, effective and what is not. In order to establish a baseline understanding of the current status of interaction and communication between HCWs and TCAM profession in Durban, South Africa, the purpose of the study was to investigate the knowledge, attitudes and practices of HCWs in the HIV and AIDS clinics towards TCAM professions. Data was collected by means of anonymous self-administered questionnaire which was distributed to HCWs in the HIV and AIDS clinics. Out of 161 HCWs in the HIV and AIDS clinics 81 HCWs returned the questionnaires resulting in 50% response rate. The results showed that participants did not possess a basic knowledge of TCAM. Out of 81 participants 23 (28%) scored zero in a true or false knowledge assessment question.
An analysis of the need for accredited training on the administration of intravenous contrast media by radiographers : results of an online survey
(The South African Radiographer, 2012) Swindon, Lynda; Friedrich-Nel, Hesta; Isaacs, Ferial; Munro, Leonie
Role extension has been debated amongst South African radiographers for a number of years. However, the administration of contrast media still remains outside their scope of practice. The Society of Radiographers of South Africa (SORSA) has received anecdotal reports that radiographers are administering contrast media. This practice is a direct infringement of the rights of patients who are required to be treated and examined by health professionals who practice within their legal scope. The aim of this survey was to investigate the views and opinions of South African radiographers regarding the injecting of contrast media and the type of training needed if it were included in the scope of practice of South African radiographers. A questionnaire was sent to 845 radiographers using an online survey programme (SurveyMonkey). The questions related to biographical information, work experience, training and the medico-legal aspects of intravenous contrast media injection by radiographers. The response rate was 21% (n=177). Eighty-one percent (81%) were diagnostic radiographers. Seventy-three percent (73%) practice radiography in a major city. There was an equal representation of the public and private sector, namely 43% for both. Of those from the public sector 47% were from a tertiary healthcare facility. More than seventy-eight percent (>78%) practice radiography in a health facility that provides radiology services. Seventy-three percent (73%) were aware of mild to moderate adverse reactions to contrast media; 45% were aware of severe adverse reactions to contrast media in their workplace. Eighty-five percent (85%) thought that accredited training should include the administration of contrast media as well as resuscitation of a patient. Sixty-two percent (62%) thought the accredited training should include pharmacology and advanced resuscitation. Ninety-three percent (93%) thought the main advantage would be an increase in service delivery to patients; 85% thought the main disadvantage would be potential risk of criminal or civil litigation. Ninety-seven percent (97%) were of the opinion that radiographers who introduce contrast media to patients must have current malpractice insurance. The results of this survey provide new information on the current status of contrast media administration to the patient whose safety and rights remain at the centre of our focus. It is recommended that the statutory body, namely the professional board for radiography and clinical technology (RCT) of the Health Professions Council of South Africa (HPCSA) takes cognizance of the outcome of this study and embarks on a more extensive survey to include a larger sample which would be more representative of the South African radiography population.
Two year clinical outcomes after sirolimus-eluting stent implantation for the treatment of coronary artery disease
(Medical Technology SA, 2012) Adam, Jamila Khatoon; Dyer, Robby B.; Harrypaul, Ashika; Rmaih, Wafaa
Background Coronary artery stents are known to reduce rates of restenosis after coronary stenting, but it is uncertain how long this benefit is maintained. Clinical data has raised concerns that drug-eluting stents are associated with increased rates of late stent thrombosis, death or myocardial infarction. Objectives To evaluate the safety and reliability of sirolimus-eluting stents in real-world practice out to two years. Methods From January 2008 to June 2008, 30 patients were enrolled in the study after implantation of one or more sirolimus-eluting stents. We evaluated clinical follow-up information for up to two years after the implantation of Cypher® Select stents in 30 patients with 35 lesions. Results Mean patient age was 62.33 +/- 10.99 years, 7 percent were diabetic and 30 percent presented with acute myocardial infarctions. The procedure’s success rate was 100 percent for the sirolimus-eluting stent implantation, and follow-up rates were 100 percent. Mean total stent length was 22.32 +/- 6.63 mm, with 13 percent receiving more than one stent. Two year freedom from mortality, myocardial infarction, target vessel revascularization and stent thrombosis was 100 percent. Dual antiplatelet therapy was taken by 100 percent at 1 month, 53 percent at 6 months, 40 percent at 1 year and 0 percent of patients at 2 years. The rate of survival free of myocardial infarction, bypass surgery and repeated angioplasty for stented lesions was 100% at two years. Conclusions Treatment of lesions with sirolimus-eluting stents is associated with a sustained clinical benefit two years after device implantation.
Acknowledging the other …
(National Association of Child Careworkers, 2012) Winfield, Jacqueline Ann
The pending loss of advanced life support paramedics in South Africa
(African Federation for Emergency Medicine, 2012) Govender, Kevin; Grainger, Linda; Naidoo, Raveen; MacDonald, Russell
Background: In 2008 South Africa (SA) had 1631 registered advanced life support (ALS) paramedics to provide pre-hospital advanced life support care to a population of approxi-mately 50 million. Compared to globally accepted ratios, the number of ALS paramedics in South Africa can be considered as grossly inadequate. This current shortage may be ascribed to migration. However, the extent and nature of this migration, the factors that have contributed to them leaving the country and the existence or effectiveness of implemented strategies that attempt to manage migration of SA ALS paramedic is not known for sure. Methods: The study consisted of a two-phase mixed method descriptive survey. A subset of SA ALS paramedics made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N = 97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n = 10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were integrated to obtain an in-depth understanding of South African ALS paramedic migration. In addition, the study investigated whether strategies that attempted to manage migration of SA ALS paramedics existed, and if they did, how effective have they been. Result: Fifty-one of 97 (53%) ALS paramedics responded to the questionnaire in Phase One. Of those, 24 (47.1%) were found to be working inside South Africa, while 27 (52.9%) were working outside South Africa. Working conditions, physical security, and economic considerations were ranked as the top three major factors contributing to the decision or intended decision to migrate. Initiatives to manage the shortage of ALS paramedics in the public sector EMS do exist; however, it appears to be inadequate at its current rate of progress. Conclusion: This study suggests that ALS paramedics in SA are leaving to ﬁnd work outside the country because of working conditions, physical security, and economic considerations. The current measures to manage migration appear to be ineffective, indicating that new or additional strategies to manage migration of ALS paramedics in SA may be required.
Thinking about the therapeutic milieu ...
(National Association of Child Careworkers, 2012) Winfield, Jacqueline Ann
Role extension : the needs, perceptions and experiences of South African radiographers in primary health care
(SORSA, 2012-05) Gqweta, Ntokozo
Escalating current health needs coupled with the dire shortage of radiologists saw many countries abroad, led by the United Kingdom, adopting radiography role extension. Radiography role extension is a practice whereby radiographers adopt duties that were previously only within the scope of practice of radiologist. This study aimed to evaluate the need, the perceptions and the lived experiences of radiographers working in primary health care with reference to radiography role extension. An interpretive qualitative research approach was utilised in trying to understand lived experiences of radiographers working in primary health care (PHC) institutions in Cape Town. A questionnaire was utilised as the data collection tool. An analysis of the qualitative data revealed six themes; (i) medico legal aspects, (ii) education, (iii) newly qualified and inexpe-rienced medical officers, (v) improving service delivery, (vi) the radiographers’ experience, and (vii) benefits of reporting radiog-raphers. It was concluded that there is evidence to support the need for radiographers to extend their roles into report writing within the PHC level. The benefits of this would be improved service delivery and optimum utilisation of the radiographers’ skills and knowledge.
The predictive value of proBNP levels to determine the presence and severity of coronary artery disease in patients with a positive or inconclusive exercise stress test
(Medical Technology SA, 2012-06) Adam, Jamila Khatoon; Pearce, A.; Naidoo, N.; Rmaih, Wafaa
Background Several clinical studies have shown increased levels of N Terminal-Pronatriuretic Peptide (NT-proBNP) during epi- sodes of coronory ischaemia. Consistent with this observation, both Brain Natriuretic Peptide (BNP) and NT-proBNP correlated to severity, location, and extent of angiographic coronary artery disease (CAD). The main objective of this study was to identify the possible value of NT-proBNP level which indicates CAD. Methods Sixty patients with signs and symptoms of CAD were recruited for this study. They were divided into two groups; Group A, consisted of thirty patients with a positive Exercise Stress Test (EST) and Group B, consisted of thirty patients with an inconclusive EST. After the EST, all patients from both groups were required to have a NT-proBNP blood test, a left and right coronary angiogram and a left ventriculogram. Results Post EST NT-proBNP levels, in both groups, increased in the presence of CAD (p<0.001). For the positive EST group, the area under the ROC curve was 0.975 (p<0.001). A cut- off value of 120 pg/ml was identified with the highest sensitivity (95.7%) and specificity (100%). For patients in the inconclusive EST group, the area under the ROC curve was 0.912 (p<0.001). A cut-off value of 85 pg/ml was identified with the highest sensitivity (87.5%) and specificity (86.4%). Conclusion EST is relatively inaccurate at predicting CAD in patients with inconclusive ESTs. The need for an additional tool, such as NT-proBNP measurements post inconclusive EST is warranted in the determination of the presence of CAD.
Poor academic performance : a perspective of final year diagnostic radiography students
(Elsevier, 2012-08) Gqweta, Ntokozo
Introduction A study was conducted on final year diagnostic radiography students at a University of Technology in Durban. The aim of the study was to investigate the final year diagnostic radiography students' opinions and views on academic performance in order to inform teaching and learning methods. The objectives were • To explore the students' opinions regarding poor performance. • To identify strategies to improve academic performance. Method A qualitative, interpretive approach was used to explain and understand the students' lived experiences of their academic performances. A short open ended questionnaire was administered to a cohort of final diagnostic radiography students following feedback on a written assessment. Questionnaire responses were then manually captured and analyzed. Results Five (5) themes were identified that could possibly be associated with poor academic performance. These themes were, poor preparation, lack of independent study, difficulty in understanding learning content and misinterpretation of assessment questions, inefficient studying techniques as well as perceived improvement strategies. Conclusion Students identified their inadequate preparation and the lack of dedicated independent studying as the main reasons for poor performance. Students preferred to be taught in an assessment oriented manner. However their identified improvement strategies were aligned with the learner centred approach.
Introduction of a blended teaching strategy in an occupational health nursing education programme
(Occupational Health Southern Africa, 2012-09) Orton, Penelope Margaret; Nokes, Kathleen M.
The purpose of this case study is to describe the use of a blended learning strategy to address some of the challenges experienced by adult nursing students in a specialised occupational health nursing course. These students are generally employed on a full-time basis and have a number of competing responsibilities that may impact on their studies. Blended learning using e-learning and face-to-face problem-based learning was identi- fied as a useful educational strategy to address some of the challenges faced by these students in furthering their education. A blended learning strategy addresses the main assumptions of adult education, including self-directed learning, experience as a resource for learning, readiness to learn, problem-centred orientation with immediacy of application, and internal motivation. This educational strategy is recommended for adult learners and a formal evaluation of this blended learning method is planned.
Directed evolution: tailoring biocatalysts for industrial applications
(Taylor and Francis Online, 2012-09-18) Kumar, Ashwani; Singh, Suren
Current challenges and promises of white biotechnology encourage protein engineers to use a directed evolution approach to generate novel and useful biocatalysts for various sets of applications. Different methods of enzyme engineering have been used in the past in an attempt to produce enzymes with improved functions and properties. Recent advancement in the field of random mutagenesis, screening, selection and computational design increased the versatility and the rapid development of enzymes under strong selection pressure with directed evolution experiments. Techniques of directed evolution improve enzymes fitness without understanding them in great detail and clearly demonstrate its future role in adapting enzymes for use in industry. Despite significant advances to date regarding biocatalyst improvement, there still remains a need to improve mutagenesis strategies and development of easy screening and selection tools without significant human intervention. This review covers fundamental and major development of directed evolution techniques, and highlights the advances in mutagenesis, screening and selection methods with examples of enzymes developed by using these approaches. Several commonly used methods for creating molecular diversity with their advantages and disadvantages including some recently used strategies are also discussed.
Steps that count! : The development of a pedometer-based health promotion intervention in an employed, health insured South African population
(BioMed Central, 2012-10-17) Pillay, Julian David; Kolbe-Alexander, Tracy; Mechelen, Willem; Lambert, Estelle V.
Physical activity (PA) has been identified as a central component in the promotion of health. PA programs can provide a low cost intervention opportunity, encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs. Along with these trends, there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA. This study determines the effectiveness of a worksite health promotion program comprising of a 10-week, pedometer-based intervention (“Steps that Count!”), and individualized emailbased feedback to effect PA behavioral change.Methods The study is a randomized controlled trial in a worksite setting, using pedometers and individualized email-based feedback to increase steps per day (steps/d). Participant selection will be based on attendance at a corporate wellness event and information obtained, following the completion of a Health Risk Appraisal (HRA), in keeping with inclusion criteria for the study. All participants will, at week 1 (pre-intervention), be provided with a blinded pedometer to assess baseline levels of PA. Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations. Participants will thereafter be randomly assigned to the intervention group (INT) or control group (CTL). The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks. Individualized feedback messages based on average steps per day, derived from pedometer data (INT) and general supportive/motivational messages (INT+CTL), will be provided via bi-weekly e-mails; blinded pedometer-wear will be conducted at week 12 (post-intervention: INT+CTL). Discussion The purpose of this paper is to outline the rationale behind, and the development of, an intervention aimed at improving ambulatory PA through pedometer use, combined with regular, individualized, email-based feedback. Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention.

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