Racial Disparities in the Incidence and Survival of Spinal Meningioma

Objective:

Race is a significant prognostic factor in various cancers, including the breast. Its prognostic association with spinal meningioma has not been established, although the incidence of spinal meningioma varies by race. In this retrospective cohort study, we aimed to investigate the association of race with the incidence and survival of spinal meningioma among a large population sample.

Materials and Methods:

A comprehensive search was done in the surveillance, epidemiology, and end results database between 2000 and 2016 to identify patients with spinal meningioma. Overall and race-specific incidence were calculated. The effect of race on overall survival among these patients was determined with Kaplan–Meier curve and Cox proportional hazard models.

Results:

Of 3502 spinal meningioma patients, 82.6% were Caucasian, 7.7% were African-American, 8.8% were Asian/Pacific Islander and 0.7% were American Indian/Alaska Native. The overall age-adjusted incidence was 0.239/100,000; it was highest among Caucasian (0.249) and lowest among American Indian/Alaska Native patients (0.137). There was a race effect in overall survival in the unadjusted analysis with the worst overall survival reported for Caucasian patients, and the best reported for American Indian/Alaska Native patients. However, this relationship was insignificant in the adjusted analysis.

Conclusions:

Race was not significantly associated with overall survival among these patients. Future studies should use spinal-meningioma-specific survival as outcome to see whether there is a racial difference in survival.

Motivation to teach surgery at non-university affiliated hospitals in Saudi Arabia: A qualitative study

This article was migrated. The article was not marked as recommended. Background: Most Saudi Arabian medical colleges rely on non-university affiliated hospitals for clinical training of their students. We explored what motivates or demotivates the surgeons who work in these hospitals to teach. Methods: Eighteen surgeons from five non-university affiliated hospitals in the Al-Qassim region of Saudi Arabia who were directly involved in teaching surgery participated in this qualitative study. The surgeons' in-depth interviews with a semi-structured questionnaire were audio-taped, transcribed, and analyzed to identify responses related to motivating and demotivating factors for teaching surgery. Results: Surgeons identified three unique factors related to teaching: (1) to accumulate spiritual credit for good deeds (motivating), (2) refusal by patients to be examined by trainees (demotivating), and (3) refusal by female patients to be examined by male trainees (demotivating). Additional motivating factors were self-satisfaction, earning a good reputation, updating knowledge, and witnessing the success of trainees. The demotivating factors were unenthused trainees, inadequate teaching settings at the hospitals, an absence of medico-legal protection for the trainees, a heavy workload, and no incentives for teaching activities. Conclusion: Providing student-trainees legal protection, offering incentives for teaching, and marketing the hospitals as training facilities will likely improve the teaching environment in non-university affiliated hospitals in Saudi Arabia.