The impact of housing markets on consumer debt: Credit report evidence from 1999 to 2012

We investigate the impact of large swings in the housing market on nonmortgage borrowing, including student, credit card, auto, and home equity debts. For this purpose, we use CoreLogic geographic house price variation, matched with rich data on consumer liabilities from the Equifax-sourced FRBNY Consumer Credit Panel. The length and timing of our panel allow us to study the consumer debt portfolio response to house price changes during a boom-and-bust cycle of historic magnitude as well as during more ordinary times. In first-differenced instrumental variables estimation, we find that during 1999-2001, homeowners substituted out of nonhousing (largely credit card) debt and into home equity-based debt at a nearly dollar-for-dollar rate in response to house price increases. During the housing boom of 2002-06, however, homeowners abandoned the practice of substituting into less costly debt as equity grew, and instead increased obligations across the board. From 2007-12, sample homeowners experienced a 23 percent average house price decline, and withdrew from home equity debt without adding to non-housing debt. We observe substantial heterogeneity in this pattern: Substitution in both 1999-2001 and 2007-12 ranges from 50 cents to more than dollar-for-dollar for older and prime borrowers, while the decidedly nonprime borrow more modestly, show less evidence of substitution, and shed large amounts of all types of debt from 2007-12. Finally, difference-in-differences and FD-IV estimates are consistent with both 1) a 2012 relative debt overhang of at least $1,800 on average, despite little remaining home equity advantage, for homeowners who experienced a more pronounced boom-and-bust cycle and 2) little substitution out of home equity debt into student loans in response to recent house price declines

Factors Affecting the Motivation of Expatriate English as a Foreign Language (EFL) Teachers in the Sultanate of Oman

Research in the area of English as a Foreign Language (EFL) teacher satisfaction and teacher motivation has recently gained momentum, and several studies completed in different parts of the world have contributed to this growing field (Al Hashmi, 2004; Al-Maawali, 2003; Dörnyei, 2001; Gheralis-Rouss, 2003; John, 2011; Kızıltepe, 2008; Manuel and Hughes, 2006; Menyhárt, 2008; Shoaib, 2004). However, studies from Oman, particularly with expatriate teachers, are still limited. The purpose of the current naturalistic qualitative research is to explore the factors that motivate and discourage expatriate EFL teachers in a public university in Oman. The conceptual framework of this study is based on the Needs Hierarchy theory (Maslow, 1954) and the Motivation-Hygiene theory (Herzberg, 1976). An exploratory methodology was used, and the sample selected for this study comprised exclusively expatriate teachers whose average number of years of experience in Oman is 18.75 years. In-depth semi-structured interviews with sixteen expatriate teachers revealed several intrinsic and extrinsic factors that motivated teachers to work and live in Oman, such as, interaction with students, job security, and living in Oman. Teachers also expressed several discouraging factors that affected their personal and professional life in Oman. Examples include difficulties in getting promoted, faculty evaluation surveys, and bureaucratic administrative policies. This study is significant in giving voice to experienced expatriate teachers who share their vast experience and suggestions and offer recommendations to administrators and managers on adopting policies that are holistic and present optimal working conditions to teachers

Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi

Objective: To study the health and needs of geriatric patientsMethods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and 291 (72.4%) had five or more health problems. Mobility impairment, urinary incontinence, dyspnoea, fatigue and visual impairment had the worst impact on the life of the individual. Hypertension (42.5%), diabetes mellitus (28.1%) and arthritis (26.6%) were the most commonly reported chronic ailments. Two hundred and three (50.5%) respondents were taking three or more different medications daily. A large number of people had religion (61.4%), reading (36.1%), socializing (53%) and watching television (49.5%) as a regular activity. Eighty five (21.1%) respondents reported having financial problems. Three hundred and sixty five (90.8%) respondents had spiritual needs and 264 (72.3%) reported that their spiritual needs increased with aging

Trauma Management: Should it be a part of Medical Curriculum?

Trauma management is an approach to assess and treat multiply injured patients. Casualties that present within the first twohours of injury are deaths that can be prevented. Medical professionals need to be trained to appraise and manage these patientsduring this period. A variety of courses are available, designed entirely to teach medical professionals to treat trauma patients.Many counties have adopted these programs and now they are being taught in over 60 countries worldwide. In developingcountries, injuries due to trauma are regrettably neglected, and accounts for more than five million deaths each year. This isnearly equal to combined number of deaths from tuberculosis, malaria and HIV/AIDS. Medical graduates are supposed to beable to handle all types of emergencies, common or traumatic. Lack of ATLS, BCLS and ACLS certified doctors in emergencydepartments lead to improper and un-necessary delay in provision of medical care to patients

The role of computed tomography for identifying mechanical bowel obstruction in a Pakistani population

Objective: To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction. Methods: It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was analyzed using SPSS version 16.0. Results: A total of 271 patient records were reviewed. The mean age was 46 +/- 19 years and (64%) were men. Mechanical intestinal obstruction was found in 104 patients on laparotomy and CT scan had diagnosed 97 of these. The sensitivity and specificity was 93% respectively. CT scanning correctly identified the cause of the obstruction in 72 (74%) cases. The common reasons for bowel obstruction identified by surgery were adhesions 29 (40%), neoplasm 12 (17 %) and hernias 7 (10%). Conclusion: CT scans are reliable at diagnosing intestinal obstruction with a high sensitivity and specificity but they are not as accurate at defining the etiology of the obstruction

Factors affecting the utilization of antenatal care among married women of reproductive age in the Rural Thatta, Pakistan: Findings from a community-based case-control study

Background: There are differences in antenatal care (ANC) utilization between urban and rural areas of Pakistan. Although multiple factors have been studied affecting the utilization of general health care services, the effect of road network distance particularly on the utilization of ANC has not been assessed. Therefore, this study aimed to determine the association between road network distance from a health care facility and utilization of the ANC among women of reproductive age in Thatta Pakistan.Methods: A community-based case-control study was conducted in district Thatta, Pakistan. Women who did not utilize ANC services during their last pregnancy were considered as cases, while controls were the women who utilized ANC services during their last pregnancy. Questions related to socio-demographic, access-related factors and utilization of ANC were asked from women. Road network distance was calculated from the women\u27s home to the health care facility providing ANC services. Logistic regression analysis was performed.Results: A total of 380 participants were interviewed in this study. Participants\u27 mean age and parity were 28 years (SD 5.65), and 3.5 (SD 2.6) respectively. The multivariate analysis showed that women living at a shorter distance of less than 5 km were 1.21 times likely to utilize ANC services [Adjusted OR. 1.21; 95% CI (0.49-2.99)]. Moreover, nulliparous women were 4.10 times likely to utilize antenatal care [Adjusted OR. 4.10; 95% CI (1.10-15.26)]. Similarly, women who had knowledge of antennal care were 6.60 times likely to utilize ANC services [Adjusted OR. 6.60; 95% CI (3.33-13.05)]. Women having electricity in their households were 3.15 times likely to utilize the ANC services [Adjusted OR. 3.11 95% CI (1.51-6.41)]. Women, living in well-constructed (Pakka) houses were 2.58 times likely to utilize the ANC services [Adjusted O.R: 2.58; 95% CI (1.15-5.82)].Conclusion: Road network distance has no measurable impact on ANC utilization among married women in Thatta district, Pakistan. Nulliparous women having knowledge of ANC living in well-constructed houses equipped with electricity were found to be utilizers of ANC services. It is recommended that awareness and health education sessions should be arranged for pregnant women in rural Pakistan

We won\u27t go there: Barriers to accessing maternal and newborn care in district Thatta, Pakistan

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. The study identified individual, sociocultural, and structural-level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included mistrust towards public health facilities and inadequate symptom recognition. The three identified sociocultural barriers were aversion to biomedical interventions, gendered imbalances in decision making, and women\u27s restricted mobility. The structural barriers included ineffective referral systems and prohibitively expensive transportation services. Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers

Case Report Palpable Penile Metastases: A Bizarre Presentation of Rectal Adenocarcinoma

Metastasis to the penis is an uncommon occurrence, with only about 370 cases reported in the literature to date. The majority of the primary tumors are genitourinary in origin. We report on a patient with undiagnosed disseminated rectal adenocarcinoma, who first presented with lesions of the corporal bodies. A review of the literature indicates that corporeal metastasis as an initial presentation of malignancy is an extremely rare occurrence and carries a very poor prognosis

Self-medication amongst university students of Karachi: prevalence, knowledge and attitudes

OBJECTIVE: To determine the prevalence, attitude and knowledge of self-medication amongst university students of Karachi, Pakistan. METHODS: This cross-sectional, study was conducted from Jan-Feb 2007. A convenience sample was taken from 2 medical and 2 non-medical universities of the city of Karachi, Pakistan. Data was analyzed using SPSS v 14 and associations were tested using the Chi square test. RESULTS: Of the 572 participants (mean age=21 +/- 1.8 years, Male: Female ratio=1:1.5), 295 were medical and 277 were non-medical students. The prevalence of self-medication was 76%. Forty three percent students stated that they alter the regimen of prescribed medicines while 61.9% stated that they stop taking a prescribed medicine without consulting a doctor. The most common reason for self-medication was previous experience (50.1%) and the most common symptoms were headache (72.4%), flu (65.5%), and fever (55.2%). Commonly used medicines were analgesics (88.3%), antipyretics (65.1%) and antibiotics (35.2%). Eighty seven percent of students thought self-medication could be harmful and 82.5% students thought that it was necessary to consult a doctor before taking a new medicine. There was no significant difference between the self medication practices of medical and non medical students (p=0.8) CONCLUSION: Prevalence of self-medication is high in the educated youth, despite majority being aware of its harmful effects. There is a need to educate the youth to ensure safe practices. Strict policies need to be implemented on the advertising and selling of medications to prevent this problem from escalating