Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages

Objectives@#. The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status. @*Methods@#. A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at 9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).

Effect of an Intervention Using Voice Recording of a Family Member on Patients Undergoing Mechanical Ventilator Weaning Process

Purpose@#This study aimed to determine the impact of an intervention using voice recording of family members on pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. @*Methods@#A randomized control pre-post experimental design was implemented to 53 participants, with 27 and 26 participants in the experimental and control groups, respectively. A 70-second voice recording of a family member, repeated three times at 10-minute intervals was used as an intervention for the experimental group. Meanwhile, participants in the control group used headset for 30 minutes. Structured instruments were utilized to measure pain, anxiety, agitation, and the weaning process. Wilcoxon Signed Ranks test and the Mann-Whitney U test, or χ2 test, were used for data analysis. @*Results@#The experimental group exhibited significant decrease in pain (Z = - 3.53, p < .001), anxiety (t = 5.45, p < .001), and agitation (Z = - 2.99, p = .003) scores compared with those of the control group. However, there was no significant difference between groups in the weaning process’ simplification (χ2 = 0.63, p = .727). @*Conclusion@#Intervention using family members’ voice recording effectively reduces pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. This can be actively utilized to provide a more comfortable process for patients.

Salvage of a nasal chondrocutaneous flap after a traumatic avulsion injury using a combination of treatments polydeoxyribonucleotide injection, continuous non-rebreather mask oxygen therapy, and chemical leeching: a case report

Skin avulsions are severe traumatic injuries, in which sections of skin and subcutaneous tissue are torn off from the body, and the surgical management and salvage of these injuries are quite challenging due to their high morbidity and mortality. The entire or partial loss of an avulsed flap is prone to occur. If this happens, scars can be particularly conspicuous, and additional surgery, such as skin grafts or local flaps or even composite grafts, might be required. A 24-year-old male patient presented to the emergency room with a severe traumatic avulsion injury on his nose. We used a combination of three therapies to minimize the loss of the distal portion of the avulsed flap: polydeoxyribonucleotide injection, continuous non-rebreather mask oxygen therapy, and chemical leeching. We achieved complete flap salvage of the avulsed wound, and the patient showed full satisfaction in both aesthetic and functional aspects. Although this report is confined to a single case of severe avulsed injury, we suggest this triple-combination therapy as a good combined modality for maximizing the salvage of an avulsed flap on the basis of this case and a literature review.

Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

Background@#Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method. @*Methods@#A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups. @*Results@#In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability. @*Conclusions@#We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

Intention to Delegate Clinical Practice of Medical Specialists in Accordance with the Enactment of the Scope of Practice for Advanced Practice Nurses

Purpose@#This study aimed to investigate the nationwide intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses (APNs). @*Methods@#Data were collected from October to December 2021 using Google Surveys. In total, 147 medical specialists from 12 provinces responded to the survey. The survey questionnaire was categorized into four legislative draft duties, according to the scope of practice (a total of 41 tasks): Twenty-nine tasks on treatments, injects, etc., performed under the guidance of a physician and other activities necessary for medical treatment (treatment domain); two tasks on collaboration and coordination; six tasks on education, counseling, and quality improvement; four regarding other necessary tasks. Participants were asked whether they were willing to delegate the tasks to APN. @*Results@#The intention to delegate tasks to APN was higher for non-invasive tasks such as blood sampling (97.3%) or simple dressing (96.6%). Invasive tasks such as endotracheal tube insertion (10.2%), sampling: bone marrow biopsy & aspiration (23.8%) showed low intention to delegate in the treatment domain. Participants who were older, male, and had more work careers with APN, showed a higher intention to delegate tasks. @*Conclusion@#To prevent confusion in the clinical setting, a clear agreement on the scope of APN practice as APN delegated by physicians should be established. Based on this study, legal practices that APN can perform legally should be established.

Diagnostic Tools for Alzheimer’s Disease: A Narrative Review Based on Our Own Research Experience

Alzheimer’s disease (AD), one of the most representative neurodegenerative diseases, has diverse neurobiological and pathophysiological mechanisms. Treatment strategies targeting a single mechanism have repeated faced failures because the mechanism of neuronal cell death is very complex that is not fully understood yet. Since complex mechanisms exist to explain AD, a variety of diagnostic biomarkers for diagnosing AD are required.Moreover, standardized evaluations for comprehensive diagnosis using neuropsychological, imaging, and laboratory tools are needed. In this review, we summarize the latest clinical, neuropsychological, imaging, and laboratory evaluations to diagnose patients with AD based on our own experience in conducting a prospective study.

Ultrafast MRI and T1 and T2 Radiomics for Predicting Invasive Components in Ductal Carcinoma in Situ Diagnosed With Percutaneous Needle Biopsy

Objective@#This study aimed to investigate the feasibility of ultrafast magnetic resonance imaging (MRI) and radiomic features derived from breast MRI for predicting the upstaging of ductal carcinoma in situ (DCIS) diagnosed using percutaneous needle biopsy. @*Materials and Methods@#Between August 2018 and June 2020, 95 patients with 98 DCIS lesions who underwent preoperative breast MRI, including an ultrafast sequence, and subsequent surgery were included. Four ultrafast MRI parameters were analyzed:time-to-enhancement, maximum slope (MS), area under the curve for 60 s after enhancement, and time-to-peak enhancement.One hundred and seven radiomic features were extracted for the whole tumor on the first post-contrast T1WI and T2WI using PyRadiomics. Clinicopathological characteristics, ultrafast MRI findings, and radiomic features were compared between the pure DCIS and DCIS with invasion groups. Prediction models, incorporating clinicopathological, ultrafast MRI, and radiomic features, were developed. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to evaluate model performance in distinguishing between the two groups using leave-one-out cross-validation. @*Results@#Thirty-six of the 98 lesions (36.7%) were confirmed to have invasive components after surgery. Compared to the pure DCIS group, the DCIS with invasion group had a higher nuclear grade (P < 0.001), larger mean lesion size (P = 0.038), larger mean MS (P = 0.002), and different radiomic-related characteristics, including a more extensive tumor volume; higher maximum gray-level intensity; coarser, more complex, and heterogeneous texture; and a greater concentration of high graylevel intensity. No significant differences in AUCs were found between the model incorporating nuclear grade and lesion size (0.687) and the models integrating additional ultrafast MRI and radiomic features (0.680–0.732). @*Conclusion@#High nuclear grade, larger lesion size, larger MS, and multiple radiomic features were associated with DCIS upstaging.However, the addition of MS and radiomic features to the prediction model did not significantly improve the prediction performance.

Central diabetes insipidus following COVID-19 mRNA vaccination: a case report / 고신대학교의과대학학술지

The coronavirus disease 2019 (COVID-19) has been a major public health emergency worldwide. Vaccines were rapidly developed and approved to prevent the spread of viral infection. However, various side effects of the COVID-19 messenger RNA (mRNA) vaccines have been reported after their commercialization. A 24-year-old man visited our emergency department with polyuria and polydipsia that occurred after he received a COVID-19 mRNA vaccine 10 days beforehand. The initial laboratory findings showed very low urine osmolality with hyperosmolar hypernatremia. Based on these findings, diabetes insipidus was suspected, and sella magnetic resonance imaging showed an enlarged pituitary gland and the absence of posterior pituitary higher intensity. After 12 hours of using oral desmopressin acetate, urine volume decreased, and after 5 days of administration, serum electrolyte and serum osmolality improved. This case report of diabetes insipidus occurring after vaccination with the BNT162b2 mRNA COVID-19 vaccine is presented as a reminder that close monitoring is necessary for patients with polyuria and polydipsia after vaccination.

Mean and Variability of Lipid Measurements and Risk for Development of Subclinical Left Ventricular Diastolic Dysfunction

Background@#Subclinical left ventricular diastolic dysfunction (LVDD) is an emerging consequence of increased insulin resistance, and dyslipidemia is one of the few correctable risk factors of LVDD. This study evaluated the role of mean and visit-to-visit variability of lipid measurements in risk of LVDD in a healthy population. @*Methods@#This was a 3.7-year (interquartile range, 2.1 to 4.9) longitudinal cohort study including 2,817 adults (median age 55 years) with left ventricular ejection fraction >50% who underwent an annual or biannual health screening between January 2008 and July 2016. The mean, standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB), non-HDL-C, and triglycerides were obtained from three to six measurements during the 5 years preceding the first echocardiogram. @*Results@#Among the 2,817 patients, 560 (19.9%) developed LVDD. The mean of no component of lipid measurements was associated with risk of LVDD. CV (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.10 to 1.67), SD (HR, 1.27; 95% CI, 1.03 to 1.57), and VIM (HR, 1.26; 95% CI, 1.03 to 1.55) of LDL-C and all the variability parameters of apoB were significantly associated with development of LVDD. The association between CV-LDL and risk of LVDD did not have significant interaction with sex, increasing/decreasing trend at baseline, or use of stain and/or lipid-modifying agents. @*Conclusion@#The variability of LDL-C and apoB, rather than their mean, was associated with risk for LVDD.

Self-care in Patients with Atrial Fibrillation Based on the Theory of Unpleasant Symptoms / 임상간호연구

Purpose@#This study aimed to identify the relationships among disease severity, anxiety, depression, social support, unpleasant symptoms and self-care among patients with atrial fibrillation based on the unpleasant symptom theory, and to examine the mediating effects of unpleasant symptoms. @*Methods@#A cross-sectional study was conducted. The participants were 216 patients with atrial fibrillation who were being followed up on an outpatient basis at a university hospital in Seoul. Data were collected from November 1, 2020 to June 30, 2021, using self-report questionnaires. Data were analyzed using IBM SPSS/WIN 27.0 and PROCESS macro with 95% bias-corrected bootstrap confidence interval(CI). @*Results@#The average age of participants in this study was 66.0years. Disease severity (β=10.19,p<.001) and depression (β=1.53, p<.001) had significant positive relationships with unpleasant symptoms. Also, unpleasant symptoms (β=-0.03, p=.006) had a negative relationship with physical activity, which is a subscale of self- care. Social support (β=0.06, p<.001) was positively related with physical activity. Unpleasant symptoms showed a mediation effect in the relationship between disease severity and physical activity (Bias corrected bootstrap CI -0.65, -0.04). Depression had an indirect effect on physical activity that was mediated by unpleasant symptoms (Bias corrected bootstrap CI -0.11, -0.00). @*Conclusion@#The findings of this study suggest that integrated strategies including physical, psychological, and social factors should be considered to promote self-care in patients with atrial fibrillation.

Mediating Effects of Role Clarity between Clinical Decision-Making Abilities and Job Stress for Advanced Practice Nurses at Tertiary Hospitals / 중환자간호학회지

Purpose@#: The purpose of this study was to identify the mediating effect of role clarity in the relationship between clinical decision-making abilities and job stress among advanced practice nurses at tertiary hospitals. @*Methods@#: The participants were 137 advanced practice nurses. The assessment tools were clinical decisionmaking in nursing scale, role ambiguity scale, and Korean occupational stress scale (KOSS-26). Data were analyzed with the SPSS/24.0 program and mediation analysis was performed according to the Baron and Kenny methods. @*Results@#: There were significant relationships between clinical decision-making abilities and job stress (r=-.33, p<.001), and role clarity and job stress (r=-.29, p=.001). Role clarity showed partial mediating effects in the relationship between clinical decision-making abilities and job stress (Z=2.02, p=.043). @*Conclusion@#: Therefore, to reduce advanced practice nurses’ job stress, it is necessary to develop a program and strategies to increase their clinical decision-making abilities.

Effect of Liquefied Digestive Medicine on the Surface of Composite Resin / 치위생과학회지

Background@#The purpose of this study is to investigate the effect of liquefied digestive medicines on the composite resin surface. @*Methods@#Three types of liquefied digestive medicines (Gashwalmyeongsu, Wicheongsu, and Saengrokcheon) were selected as experimental groups, Samdasoo and Chamisul as negative controls, and Trevi as positive controls were selected to measure pH and titratable acidity. The samples filled with resin at acrylic were made total 300, 50 per group. To evaluate the erosion risk of the composite resin, the specimens were immersed in a liquefied medicine for 1, 3, 5, 15, and 30 minutes, and then the surface microhardness was measured using the Vickers Hardness Number, and the surface change was observed with scanning electron microscope (SEM). @*Results@#The average pH of the three liquefied medicine was 3.75±0.30, the Saengrokcheon was the lowest at 3.45±0.01, and the Trevi was 4.66 and Samdasoo and Chamisul were 7.40 and 8.58, respectively. The amount of NaOH reaching pH 5.5 and 7.0 was the lowest in the order of Trevi, Gashwalmyeongsu, Wicheongsu, and Saengrokcheon. The largest surface hardness reduction value was shown in Gashwalmyeongsu (−11.85±3.73), followed by Saengrokcheon (−9.79±3.11) and Wicheongsu (−8.28±2.83), and Samdasoo (−0.84±1.56) and Chamisul (−6.24±0.42) had relatively low surface hardness reduction values. However, Trevi (−16.67±5.41), a positive control group containing carbonic acid, showed a higher decrease in surface hardness than the experimental group. As a result of observation with SEM, experimental group and positive control group, showed rough surfaces and irregular cracks, and negative control groups showed smooth patterns similar to before immersion. @*Conclusion@#The liquefied digestive medicine with low pH could weaken the composite resin surface, and the carbonic acid component could more effect on the physical properties of the composite resin than pH.

Analysis on the Key Words related to Healthcare Issues of the Prevention and Control of COVID-19 in Major Korean Newspapers, 2020 / 農村醫學 地域保健

Background@#s: This study was performed to analyze the main key words of newspaper articles related to COVID-19 in 2020 for each category of quarantine measures according to the epidemic period of COVID-19. @*Methods@#We analyzed articles related to COVID-19 in three major newspapers of Korea between February 17 and December 31, 2020. We targeted the front page articles on mondays and thursdays. The analysis of the relationship between the two variables was confirmed through the chi-square test. @*Results@#As a result of analyzing the main key words for each category of quarantine measures, non-pharmaceutical intervention were the most common at 54.3%, followed by 3Ts(test, tracing, treatment and vaccine) at 31.9%. In the category of non-pharmaceutical intervention, social distancing was the most common at 33.9%. In the categories such as 3Ts(test, tracing, treatment) and vaccine, diagnostic tests were the most common at 41.8%. @*Conclusions@#It was identified that non-pharmaceutical intervention were the most common, and there was a difference in the reporting of main key words by category of quarantine measures for each epidemic period related to COVID-19 in 2020.

Systematic Literature Review on Coronavirus Infectious Disease-19 and Dental Masks / 치위생과학회지

Background@#Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted primarily through droplets, and dental practitioners are at risk of occupational exposure to SARS-CoV-2 infection owing to direct contact with the patient’s mouth, aerosols from dental procedures, and saliva. Wearing a mask is believed to be the best method of protection against infection, and a systematic literature review was conducted on whether the dental masks used in dentistry are effective in preventing Coronavirus Infectious Disease-19 (COVID-19). @*Methods@#We used PubMed, Google Scholar, DBpia, NDSL, and KISS databases for this study. Of the 917 documents narrowed down by the search terms “Coronavirus, COVID-19, and dental,” 83 documents were collected and studied. Ultimately, 42 of these papers were selected for analysis after considering duplication from the flow chart of the literature selection process. @*Results@#While dental masks are often used when treating patients with unknown COVID-19 status, the Ministry of Food and Drug Safety stated that the use of dental masks is insufficient in preventing cross-transmission of COVID-19; instead, it was recommended that N95 masks, which correspond to KF94 masks, should be worn daily. On the other hand, wearing a dental mask and following precautions such as hand hygiene may not pose a significantly higher risk of infection than wearing an N95 mask when treating COVID-19 patients. @*Conclusion@#There is an ongoing discussion regarding the use of dental masks when treating dental patients, and many argue that different types of masks should be selected according to the degree of infection and the individual's respiratory condition. By considering the safety and efficacy of dental masks in preventing infection, improvements can be made in the management of COVID-19 and dental-related infections.

Effects of a Video Education Program for Caregivers on the Maintenance of Peripheral Intravenous Catheter among Hospitalized Children / 임상간호연구

Purpose@#The purpose of this study was to develop a video education program (VEP) for the caregivers and to verify its effectiveness on the maintenance of a peripheral intravenous catheter (PIVC) among hospitalized children. @*Methods@#The VEP was developed through a literature review, educational need assessment of caregivers, and interviews with pediatric nurses, and validation of an expert group. The effectiveness of the VEP was tested on 102 caregivers and their children in a children’s hospital at D city. A nonequivalent control group pretest-posttest design was used in which different types of intervention were given to caregivers in intervention group (n=51) and control group (n=51). All caregivers received brief verbal information about the PIVC maintenance. The intervention group was additionally provided with VEP using a smartphone. Data were analyzed using SPSS/Win 21.0 program. @*Results@#The caregivers’ knowledge score on PIVC maintenance in the intervention group was significantly higher than that of the control group. The numbers of flushing in case of blockage of PIVC and gauze dressing change of the intervention group was significantly lower than those of the control group. @*Conclusion@#These results suggest that the VEP developed in this study can be useful for the maintenance of PIVC among hospitalized children.

Experience of Healthcare Providers in the Advanced Practice Nurse System / 중환자간호학회지

Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

Factors Predicting afterward Childbirth for Infertile Women: The Intensity of Physical Activity

Purpose@#The aim of this study was to investigate the intensity of physical activity predicting afterward childbirth for infertile women in order to improve the development of an infertility support. @*Methods@#The complete enumeration data of the National Health Insurance Service of Korea for women who had been diagnosed with infertility in 2016 were analyzed to investigate the predictors of childbirth in 2016–2017. The data were analyzed using descriptive statistics and linear regression with SPSS. @*Results@#When age and body mass index were controlled for, intermediate intense physical activity increased the rate of childbirth, but low or heavy intensity did not. @*Conclusion@#Women who have been diagnosed with infertility should be given advice to engage in intermediate levels of physical activity in order to increase their chances of having a child.

Effects of a Video Education Program for Caregivers on the Maintenance of Peripheral Intravenous Catheter among Hospitalized Children / 임상간호연구

Purpose@#The purpose of this study was to develop a video education program (VEP) for the caregivers and to verify its effectiveness on the maintenance of a peripheral intravenous catheter (PIVC) among hospitalized children. @*Methods@#The VEP was developed through a literature review, educational need assessment of caregivers, and interviews with pediatric nurses, and validation of an expert group. The effectiveness of the VEP was tested on 102 caregivers and their children in a children’s hospital at D city. A nonequivalent control group pretest-posttest design was used in which different types of intervention were given to caregivers in intervention group (n=51) and control group (n=51). All caregivers received brief verbal information about the PIVC maintenance. The intervention group was additionally provided with VEP using a smartphone. Data were analyzed using SPSS/Win 21.0 program. @*Results@#The caregivers’ knowledge score on PIVC maintenance in the intervention group was significantly higher than that of the control group. The numbers of flushing in case of blockage of PIVC and gauze dressing change of the intervention group was significantly lower than those of the control group. @*Conclusion@#These results suggest that the VEP developed in this study can be useful for the maintenance of PIVC among hospitalized children.

Experience of Healthcare Providers in the Advanced Practice Nurse System / 중환자간호학회지

Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

Factors Predicting afterward Childbirth for Infertile Women: The Intensity of Physical Activity

Purpose@#The aim of this study was to investigate the intensity of physical activity predicting afterward childbirth for infertile women in order to improve the development of an infertility support. @*Methods@#The complete enumeration data of the National Health Insurance Service of Korea for women who had been diagnosed with infertility in 2016 were analyzed to investigate the predictors of childbirth in 2016–2017. The data were analyzed using descriptive statistics and linear regression with SPSS. @*Results@#When age and body mass index were controlled for, intermediate intense physical activity increased the rate of childbirth, but low or heavy intensity did not. @*Conclusion@#Women who have been diagnosed with infertility should be given advice to engage in intermediate levels of physical activity in order to increase their chances of having a child.