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Background Little is known about how best to support both patients and their partners in the reengagement of sexual activity (SA) after acute coronary syndrome (ACS), with sparse direct data from the partner on their needs and concerns in the area of SA support. Objectives We undertook a qualitative study to address this gap in the literature through 3 objectives from a patient and partner perspective: (1) to characterize the experience of reengaging in SA post ACS, (2) to identify needs and priorities in the area of SA support post ACS, and (3) to determine whether cardiac rehabilitation (CR) could be an acceptable point of intervention for SA support. Methods Semistructured qualitative interviews were conducted with 6 male patients who were post ACS and their partners (age range, 47–81 years). Patients were criterion sampled from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. Inductive thematic data analysis was conducted. Results Four themes were identified: “importance,” “support received,” “on their own,” and “wanting support.” Couples reaffirmed the importance of SA pre and post ACS, reported SA support as currently insufficient but articulated ways it could be improved, and reported CR as a current source of SA support but thought there could be room for improvement on the content and delivery of such information. Conclusions This study illustrates the potential value of promoting SA support for both patients who are post ACS and their partners and reports that SA support provided at CR would be viewed as important, needed, and acceptable.

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Additional file 1: Supplemental Table 1. Summary of data points extracted. Supplemental Table 2. Summary of excluded full text articles. Supplemental Table 3. Reasons for article exclusion. Supplemental Table 4. Incidence of malignancy in hot nodules reported in studies examining only hot nodules. Supplemental Figure 1. Pooled odds ratio of combined hot nodules compared with non-toxic nodules excluding pediatric patients and those with known TSHR mutations.

Sonia Butalia,1– 4 Gilaad G Kaplan,1– 3 Bushra Khokhar,2 Sydney Haubrich,5 Doreen M Rabi1– 4,6 1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 3O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 4Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 5Ward of the 21st Century, University of Calgary, Calgary, Alberta, Canada; 6Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, CanadaCorrespondence: Sonia ButaliaDivision of Endocrinology and Metabolism, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, CanadaTel +1 403-955-8327Fax +1 403-955-8249Email sbutalia@ucalgary.caAbstract: Type 1 diabetes is the result of autoimmune-mediated destruction and inflammation of the insulin-producing β-cells of the pancreas. The excess morbidity and mortality from its complications coupled with its increasing incidence emphasize the importance to better understand the etiology of this condition. It has a strong genetic component, but a genetic predisposition is not the sole contributor to disease development as only 30% to 50% of identical twins both develop the disease. In addition, there are multiple lines of evidence to support that environmental factors contribute to the pathogenesis of type 1 diabetes. Environmental risk factors that have been proposed include infections, dietary factors, air pollution, vaccines, location of residence, childhood obesity, family environment and stress. Researchers have conducted many observational studies to identify and characterize these potential environmental factors, but findings have been inconsistent or inconclusive. Many studies have had inherent methodological issues in recruitment, participation, defining cases and exposures, and/or data analysis which may limit the interpretability of findings. Identifying and addressing these limitations may allow for greatly needed advances in our understanding of type 1 diabetes. As such, the purpose of this article is to review and discuss the limitations of observational studies that aim to determine environmental risk factors for type 1 diabetes and propose recommendations to overcome them.Keywords: type 1 diabetes, risk factors, epidemiology

Background The objective of this study was to conduct a systematic review with meta-analysis of studies assessing the association between living in an urban environment and the development of the Crohn’s disease (CD) or ulcerative colitis (UC). Methods A systematic literature search of MEDLINE (1950-Oct. 2009) and EMBASE (1980-Oct. 2009) was conducted to identify studies investigating the relationship between urban environment and IBD. Cohort and case–control studies were analyzed using incidence rate ratio (IRR) or odds ratio (OR) with 95 % confidence intervals (CIs), respectively. Stratified and sensitivity analyses were performed to explore heterogeneity between studies and assess effects of study quality. Results The search strategy retrieved 6940 unique citations and 40 studies were selected for inclusion. Of these, 25 investigated the relationship between urban environment and UC and 30 investigated this relationship with CD. Included in our analysis were 7 case–control UC studies, 9 case–control CD studies, 18 cohort UC studies and 21 cohort CD studies. Based on a random effects model, the pooled IRRs for urban compared to rural environment for UC and CD studies were 1.17 (1.03, 1.32) and 1.42 (1.26, 1.60), respectively. These associations persisted across multiple stratified and sensitivity analyses exploring clinical and study quality factors. Heterogeneity was observed in the cohort studies for both UC and CD, whereas statistically significant heterogeneity was not observed for the case–control studies. Conclusions A positive association between urban environment and both CD and UC was found. Heterogeneity may be explained by differences in study design and quality factors.