Jacquelyn Judith Cragg

This article critically appraises the study by Nakken et al., "Duration of Current Statin Use and Amyotrophic Lateral Sclerosis (ALS) Risk." Previous observational studies and Mendelian randomization studies examining statin use and ALS risk have reported mixed results. Millions of adults receive statins for cardiovascular prevention and may be concerned when neuromuscular symptoms suggestive of ALS appear. Using linked nationwide health survey and prescription data, this Norwegian population-based cohort study applied time-dependent models to evaluate statin use and subsequent ALS risk. Short-term statin use was associated with increased ALS risk, whereas long-term use was associated with lower risk. The authors interpreted this as evidence of reverse causation rather than a causal or protective effect of statins. Key strengths of the study include its large population-based design, the use of a negative control, and time-dependent Cox modeling. However, limitations inherent to observational study designs and potential residual confounding should be considered. In this article, we summarize the findings, highlight key statistical concepts, and discuss the study's major strengths and limitations.

Study Design Retrospective cohort study. Objectives The primary objective was to examine changes in gabapentinoid prescribing among individuals with acute spinal cord injury. The secondary objective was to examine the effects of gabapentinoid prescriptions on neurological recovery. Setting Intensive Care Unit, Vancouver General Hospital, British Columbia, Canada. Methods Individuals admitted between 2010 and 2019 with cervical spinal cord injuries were identified from the Rick Hansen Spinal Cord Injury Registry (RHSCIR). The primary outcome was first gabapentinoid prescription following injury, and exposure was year of injury. The secondary outcome was recovery in sensorimotor function, measured by changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades between admission and discharge. We analyzed associations between gabapentinoid prescriptions and year of injury using Cox regression, and neurological recovery using multivariable logistic regression. Results Of 257 individuals with cervical spinal cord injury, 79% (n = 204) were prescribed a gabapentinoid within 30 days of injury. Rates of gabapentinoid prescription in the 30 days following injury increased from 41% in 2010/2011 to 93% in 2018/2019. In a subgroup analysis of individuals with incomplete injuries, early (i.e., hyperacute; <5 days post-injury) gabapentinoid use was significantly associated with greater neurological recovery (adjusted OR = 2.9, 95% CI, 1.1 to 7.9). Conclusions Gabapentinoid prescribing in acute spinal cord injury shifted markedly between 2010 and 2019, and was associated with improved neurological recovery in individuals with incomplete injuries. Further study is warranted to assess prescribing practices at other acute care hospitals and to characterize long-term safety.

Our objective was to conduct a scoping review and narrative synthesis of qualitative studies that examined experiences of partners of cancer patients. We searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus for qualitative studies involving adult (≥18 years) partners (e.g., in a romantic relationship) of patients diagnosed with cancer and published in English. We extracted findings from included studies, along with key study and participant characteristics, and applied a narrative summary approach, a process that allowed us to identify synthesized themes across studies. Our search identified 15,729 records, of which 159 met the inclusion criteria. Included studies primarily collected data through interviews, with participants being predominantly female and middle-aged (55.2 ± 8.3 years). Partners were commonly in relationships with patients diagnosed with breast, genital–urinary, or gastrointestinal cancer. Our synthesis identified four conceptual themes—transformation of relationship dynamics and roles, distress and burden, coping strategies, and unmet needs and support gaps—which reflect the emotional, relational, and practical challenges partners navigate throughout the cancer trajectory. These findings highlight the need to better recognize and support the role of partners within the cancer care landscape as their wellbeing impacts care and experiences of patients with cancer.

Supplementary Materials and Methods: DAGitty code for Figure 1

Directed acyclic graphs (DAG) are increasingly recognized as powerful tools in research and can be used for elucidating complex causal relationships inherent in cancer development, progression, and treatment outcomes. In oncology, in which multifactorial risk factors are the norm, the ability to visualize and interrogate these relationships is critical. In observational studies, DAGs offer a rigorous framework for identifying confounders, mediators, and colliders, allowing researchers to estimate causal effects. This study presents the development and application of a DAG in a real-world observational study involving skin cancer. We outline practical steps for constructing DAGs and discuss how to use them to select variables that help control for confounding. Our approach provides a valuable guide for oncologists, epidemiologists, and other cancer researchers aiming to enhance the transparency and validity of causal claims across a wide range of oncologic contexts—from prevention and early detection to survivorship and health disparities.

Female genital mutilation/cutting (FGM/C) encompasses medically unnecessary procedures involving the partial or total removal of external genitalia. FGM/C causes lasting physical and psychological harm. While most prevalent in parts of Africa, FGM/C has been increasingly documented in Western countries due to global migration. Despite this, national epidemiological data on FGM/C in the United States (US) are not available. We estimated inpatient FGM/C diagnoses using national hospitalization data. Between 2016 and 2022, 8,680 hospitalizations included an FGM/C diagnosis, averaging 3.16 per 10,000 pregnancy-related hospitalizations. Among the 8,680 hospitalizations identified with FGM/C, unspecified types accounted for 55.3% of admissions, followed by Type III (infibulation, 17.0%) and Type II (excision, 14.5%). Across FGM/C subtypes, rates were highest for patients aged 20-39 (90.3%) and among Black females (72.7%). FGM/C diagnoses appear in US health encounters, yet gaps in clinical recognition and documentation underscore the urgent need for improved surveillance, reporting, and culturally informed care.