Financial Difficulties Research Articles

Change in Quality of Life in Patients with Advanced Rectal Cancer Between 2010 and 2022

Background/Objectives: Advanced rectal cancer is one of the most common cancers worldwide and has a significant impact on public health. Because favorable and long-term survival has been achieved with multimodal therapy, patient quality of life is very important. The intention of this study was to assess patients’ quality of life using various functioning and symptom scores from the years 2010 to 2022 and to examine changes over time. Methods: Data on health-related quality of life were collected from rectal cancer patients treated at the University Hospital Erlangen in Germany over a period of 13 years. The EORTC QLQ-C30 questionnaire and the rectal cancer-specific module QLQ-CR38 were completed in this study by a total of 516 patients. The questionnaires were collected before, during and at annual follow-up visits after treatment. Statistical significance was defined as p-values < 0.05 as well as a difference of 10 or more percentage points. Results: The deterioration in scores is most pronounced immediately after radiochemotherapy, especially for pain (+19.8 pp), fatigue (+16.1 pp) and diarrhoea (+24.8 pp). One year after the end of therapy, most of the values are again comparable to or better than those of the German general population and only role functioning (−19.8 pp), social functioning (−24.6 pp), diarrhoea (−21.6 pp) and financial difficulties (−16.3 pp) are considerably worse. Some baselines deteriorate clearly over time from 2010 to 2022; these are role functioning (−23.9 pp), social functioning (−17.3 pp), body image (−15.2 pp), fatigue (+13.8 pp) and nausea and vomiting (+10.5 pp). Conclusions: An improvement in therapy in terms of a reduction in side effects and, thus, an improvement in quality of life over time could not be proven. The deterioration in individual scores over time does not appear to be a problem specific to rectal cancer patients, but rather, is associated with social developments or systemic healthcare factors in German society that are not directly related to oncological diseases.

Emotions and difficulties experienced by parents of children with autism: A qualitative study.

This study was performed to determine the difficulties experienced by the parents of children with autism. A qualitative method was used to determine the difficulties experienced by the parents. The sample of the study consisted of parents with 24 children with autism who met the inclusion criteria. The data were analysed by the MAXQDA qualitative data analysis programme in accordance with Colaizzi's seven-stage method. Total of 5 themes and 29 codes were gathered in line with the data obtained from the interviews. Five main themes of the interviews emerged; emotions experienced by parents; adaptation to family life; difficulty in social relationships; limited opportunity for entertainment/activity and financial difficulty. Parents whose income were less than or equal to their expenses particularly stated that they had economic difficulties in the transportation of their children to places such as hospitals/schools/special education. In accordance with the findings of this study, it was determined that almost all of the parents with a child diagnosed with autism experienced sadness, denial, shock, depression, self-blame in the period when their children were first diagnosed, and later accepted the disease. In addition, it was detected that parents had difficulties in family relations, social relations, entertainment/activity and economic aspects.

Implementation Execution Decision Court Industrial Relations Bandung Dispute over Termination of Employment Through Bankruptcy

Study This discusses the implementation execution decision of the Court Industrial Relations (PHI) Bandung-related dispute Termination Connection Work (PHK) through mechanism bankruptcy. PHI decisions often face​ constraints in implementation, especially in unsolved layoff disputes that can quickly be executed. Bankruptcy is one of the instruments used​ to ensure workers' rights are fulfilled when the Company has financial trouble. Research This is to study how the bankruptcy process can be used as a road alternative for finishing layoff disputes and challenging the law's implementation. The research uses a legal normative approach supported by case PHI Bandung decision studies. Research results show that although Bankruptcy can become a practical solution, it requires synergy between the court and curator so execution can run optimally.

Денежные знаки Юга России при А.И. Деникине: историографический обзор

The aim of the study is to present a historiographical review and identify the peculiarities of the issue and circulation of Rostov paper money signs of A.I. Denikin. The article examines the issuance of various banknotes in Southern Russia during the Civil War years, predominantly focusing on the Don rubles and Denikin’s currency. It is emphasized that, in comparison with other regional currencies, these notes remained relatively stable due to both their higher quality and a stringent exchange rate tied to the German mark (up until early 1919). Furthermore, A.I. Denikin himself understood the significance of the financial issue and endeavored to address the financial difficulties through various measures. However, scientists cite a number of reasons why a full-fledged solution to this issue could not be found, and Denikin’s money quickly lost value because of the unsecured issue. Scientific novelty of the study lies in the fact that there is currently no separate article addressing Denikin’s banknotes which also includes a historiographical overview on this subject.

Impact of Debt Composition and Accounting Conservatism on Financial Distress in Emerging Markets

Aims: This study investigates the impact of debt composition, specifically short-term and long-term debt, on corporate financial distress, focusing on the moderating role of accounting conservatism. It aims to understand how firms in emerging markets, particularly Kenya, can achieve financial stability through prudent debt structuring and conservative accounting practices. Study Design: The research adopted an explanatory research design. Place and Duration of Study: The study utilized financial data from firms listed on the Kenyan Securities Exchange between 2008 and 2021. Methodology: The study analyzed a sample of 45 firms trading at the Nairobi Stock Exchange over 14 years from 2008 to 2021. The study used panel logistic regression, a statistical method for analyzing data with multiple observations over time, to test its hypotheses. Results: The results show that both short-term and long-term debt increase the likelihood of financial distress, with accounting conservatism further intensifying the risk for firms heavily reliant on short-term debt while mitigating it for those with long-term debt. This suggests that conservative accounting practices, which promote early recognition of losses, may exacerbate financial distress for firms heavily reliant on short-term debt. In contrast, for long-term debt, accounting conservatism has a mitigating effect helping firms manage their debt obligations more effectively over time. This highlights a nuanced role of accounting conservatism, where it increases the pressure on firms with short-term debt while providing stability for those with long-term obligations. Conclusion: The findings suggest that corporate managers in emerging markets should carefully balance short- and long-term debt to minimize financial distress risks. Additionally, adopting conservative accounting practices can serve as a safeguard, providing early warning signals for financial trouble and enhancing corporate stability. Managers should therefore carefully balance short-term and long-term debt to reduce financial distress while adopting conservative accounting practices to enhance financial transparency and risk management. Policymakers can support firms by promoting responsible debt management and offering incentives for conservative financial reporting to strengthen overall financial stability.

Impact of caring for patients with polyhandicap on institutional health care workers' quality of life: a cross-sectional and longitudinal evaluation.

Profound intellectual multiple disabilities or polyhandicap (PLH) is defined as a combination of profound mental retardation and serious motor deficits resulting in extreme dependence. Support for these patients is multidisciplinary, complex, and time-consuming. Thus, institutional health care workers (HCWs) face specific working conditions: frequent physical tasks, distressed families, and restricted feedback. We aimed to identify determinants of quality of life (QoL) of HCWs and to study longitudinal evolution. The study used data from the French cohort EVAL-PLH. The participants were institutional HCWs of persons with PLH (age ≥ 3 years at the time of inclusion; age at onset of cerebral lesion <3 years old). Two populations were used: (1) cross sectional study: the sample 1 includes the HCWs assessed at T2 (2020-2021); (2) longitudinal study: the sample 2 includes the HCWs assessed at both T1 (2015-2016) and T2 (2020-2021). The data collected included: sociodemographics, health status, professional variables, and psycho-comportemental aspects. QoL was assessed using WHOQOL-BREF which provides 4 scores. In comparison with French norms, the physical and social scores of QoL were significantly lower while the psychological score was significantly higher for (i) the 223 HCWs (participation rate 62%) assessed at T2 and (ii) the 61 HCWs assessed at T1 and T2. The main factors modulating QoL were age, marital status, self-perceived financial difficulties, personal chronic disease, anxiety-mood disorders, nature of coping strategies, and burnout. This study confirms the mixed (negative and positive) impact of caring persons with PLH on the institutional HCWs' QOL. Main determinants of the HCW's QOL were: older age, single status, perceived financial difficulties, altered health status, burn out and coping strategies.Clinical trial registration number: NCT02400528.

Struggling with studying and earning – realities of the UK's cost-of-living crisis on students on social work programmes

ABSTRACT The UK has been experiencing an extended cost-of-living crisis since 2021 and students attending universities have struggled with the impacts of rising prices. This article reports on findings from a study to explore local recruitment and retention issues in adult social care from the perspective of different populations of interest in the South of England. A mixed methods approach was undertaken. One group of participants were students enrolled in social work undergraduate and postgraduate programmes. They completed an online questionnaire (n = 20), with a subsample (n = 11) being interviewed. Comments relating to the wide-ranging effects of cost-of-living issues discussed by the participants were themed together and are described. The findings offer suggestions to evaluate student support mechanisms and reduce the potential impacts of ongoing financial difficulties caused by the need to juggle course, placement and financial demands across this and other applicable undergraduate sectors and their programmes. They also reflect risks to future workforce recruitment alongside the potential of ‘earn and learn’ programmes, such as apprenticeship routes – which may offer a viable alternative to qualification for those at particular risk of financial hardship whilst studying.

Navigating the challenging storms of cancer management in a national cancer centre: perspectives of female patients

BackgroundBreast, cervical, and ovarian cancers are among the top ten global cancers, affecting women, with age-standardized rates per 100,000 being 47.8 for breast, 13.3 for cervical, and 6.6 for ovarian cancer. The journey from cancer symptoms, through diagnosis and treatment, to survivorship, presents numerous challenges. These challenges encompass physical, psychological, and social aspects, significantly impacting patients' quality of life. It is crucial for research to explore not only the challenges faced by patients but also the strategies they employ to cope with these obstacles.MethodsThis study employed a cross-sectional qualitative approach. Twenty respondents, aged between 15 and 45 years and had been diagnosed with a reproductive cancer (breast, ovarian, or cervical), and were either undergoing treatment or had completed treatment within one year of the study period were purposively selected. Respondents were interviewed using a semi-structured interview guide. A thematic analysis was conducted on twenty in-depth interviews (IDIs) to understand the challenges and support systems for cancer patients.ResultsThe study identified two principal themes: the challenges faced by patients and the available support systems. The findings are based on patient narratives regarding the obstacles encountered during diagnosis, treatment, and follow-up, along with the mitigation strategies employed. Patients reported a range of challenges, categorized into financial and non-financial. Prominent among the non-financial challenges were psychological distress, body image issues, reduced sexual drive, and overall health deterioration. Support was primarily found through personal relationships and religious or spiritual beliefs.ConclusionThe research highlights the extensive psychological and social effects of cancer and it’s treatment. The study revealed the intertwined nature of financial difficulties and non-financial challenges, emphasizing the importance of social support, including religious, family, healthcare, and peer support. The findings suggest that a comprehensive, multidisciplinary management plan which encompasses both medical and supportive care is required to enhance patient well-being.

Depression in the schistosomiasis japonica population based on the PHQ-9 scale: a cross-sectional survey from Jiangxi Province, China

Depression is the second leading-cause of disability in China. Although studies have shown that more than 80% of patients with advanced schistosomiasis (AS) suffer from anxiety and depression, these study groups are all hospitalized patients with AS and do not represent the extent of the disease in the whole group. To our knowledge, there are no studies assessing the severity of depression in patients with other forms of schistosomiasis japonicum. Therefore, it is necessary to evaluate the occurrence and potential risk factors of depression in the schistosomiasis endemic population. This cross-sectional study was conducted in Jiangxi Province, where schistosomiasis is relatively common in China, as the investigation site. The Patient Health Questionnaire-9 (PHQ-9) scale was selected to assess the depressive symptoms in the study population. At the same time, basic personal information of the research subjects and relevant socio-economics and schistosomiasis endemic area indicators were collected. The survey results show that AS has the highest incidence of depression (34.35%), while non-advanced schistosomiasis (N-AS) and control group (CG) have 22.35% and 22.24% respectively; the incidence of depression in AS is significantly higher than in N-AS and CG, while there is no statistical significance in the comparison between N-AS and CG; the incidence of mild depressive symptoms accounts for 61.08%-75.54% of the total incidence of depression in different groups; multivariate analysis shows that the occurrence of moderate/severe depressive symptoms in the AS group was significantly related to above 60 years old, male, the combination of other serious diseases, personal financial difficulties, and marshland and lake endemic areas. In the N-AS group, the occurrence of moderate/severe depressive symptoms was significantly related to the combination of other serious diseases, personal financial difficulties, significant correlation between marshland and lake endemic areas and the level of control of schistosomiasis epidemics. In conclusion, depression is still relatively common among patients with schistosomiasis patients, especially those with AS. It is recommended that the government and relevant departments consider mental health care when developing prevention and control work in schistosomiasis-endemic areas, in order to effectively protect the physical and mental health of schistosomiasis patients and residents in endemic areas.

Post-traumatic reactions and quality of life after pelvic exenteration for gynecologic cancer: a retrospective cohort study.

We examined post-traumatic reactions and quality of life in women with recurrent gynecologic cancer who underwent a pelvic exenteration (PE), a potentially life-saving radical surgery associated with life-altering sequelae. Twenty-one women who had completed PE at least 6months prior completed the Impact of Event Scale-Revised, a measure of post-traumatic stress, the Post-Traumatic Growth Inventory, a measure of post-traumatic growth, the Center for Epidemiologic Studies-Depression Scale, and the European Organization for Research and Treatment of Cancer 30-item core Quality of Life Questionnaire. We examined the associations between these outcome variables, and quality of life scores were compared to normative values for the general and gynecologic cancer populations. Thirty percent of women reported clinically significant post-traumatic stress symptoms and 71% endorsed clinically significant depressive symptoms. More post-traumatic stress was associated with less post-traumatic growth, more depressive symptoms, and worse quality of life. In general, women's quality of life was worse than the general population but comparable to women with stage III-IV ovarian cancer and women with cervical cancer. Social functioning was markedly lower in our sample and women reported more pain, diarrhea, and financial difficulties post-PE compared to published norms for the general population and women with ovarian or cervical cancer. There were no differences in quality of life based on age, type of PE, type of urinary diversion, or cancer type. Findings support long-term continued symptom management and the ongoing rehabilitation of patients to optimize physical, psychological, and social well-being in PE survivorship.

Addressing ‘difficulty in dining’ among older adults: optimizing community senior dining halls from external and internal built environments

Many developed and developing countries, including China, are facing the challenges of the aging population. One such challenge is the difficulty for some older adults to access nutritious hot meals to maintain their health and well-being. Community-based senior dining halls (CSDHs) providing low-cost meals for older adults are a widespread model across China and neighboring countries, which aim to cater to the dining needs of older adults within local communities. However, most CSDHs face financial difficulties due to low dining volume. Hence, understanding how built environment characteristics are associated with the dining volume can potentially increase the dining volume and financial sustainability of CSDHs in the long run. This study analyzed the association between the dining volume and both the external and internal built environment of 50 CSDHs in Guangzhou, China. By using multiple linear regression models with three different buffer sizes (400 m, 600 m, and 800 m), we found that 1) among the external built environment characteristics, floor area ratio (FAR) and distance to the nearest subway station are negatively linked to the dining volume; 2) among the internal built environment characteristics, floor level is negatively associated with dining volume, whereas availability of dine-in seating and water dispenser, and number of seats are positively associated with it. Hence, a well-designed external and internal built environment of CSDHs may increase dining volume, enhance social interaction among older adults, and support community-based senior care.

The Art of Not Stopping: Grit Among the Breadwinner Senior Citizens in Pilar, Bataan

Approximately fifty percent of elderly individuals in the Philippines are currently employed. A significant number of them are exposed to health hazards and have a low socioeconomic level despite having worked for a considerable number of years. The current study aims to provide a detailed account and analysis of the core essence of the experience of breadwinner senior citizens as they strive to maintain their grit for numerous years. The findings revealed four themes, or 4K of grit, namely: keep on, keep at, keep up, and keep growing. Each theme generated subthemes that further elaborated on the experiences of breadwinner senior citizens. Keep on is divided into five subthemes: familial’s sake, financial autonomy, fortitude in the past, and founding leisure. Keep at is divided into two themes, namely the personification of aging and perceived hardships. Meanwhile, the keep-up had four subthemes: guarding the mind, being God-centered, getting support, and having greater focus in the body. Lastly, the keep growing is composed of two themes the steadfastness in work and senescence’s’ joy. While the participants have shown resilience in the face of several challenges, it is strongly recommended that local government agencies improve and closely supervise the current program and activities aimed at addressing the financial difficulties as well as the physical and mental difficulties of the breadwinner senior citizens. More so, the said research will add additional fund of knowledge in the field of gerontology and psychology in the Philippines.

Use of free preventive dental programme for children: 10 years of Lov'U'r Teeth, France.

Lov'U'r Teeth is a French oral health prevention programme targeting children. The programme offers an appointment with a dentist for oral examination and individual oral health advice. It covers any necessary primary dental care resulting from that examination. Despite being free, it was under-utilised at its previous evaluation 10 years ago. The study aims to identify the determinants of participation and their evolution since 2009. We worked on the General Beneficiary Sample, a medico-administrative database representative of the French population, including health-care consumption data. We selected individuals aged 6 to 15. We performed descriptive statistics and multivariate logistic regressions to analyse and compare the determinants of participation between 2009 and 2019. The final sample included 26 288 children. Lov'U'r Teeth participation rate increased by 4.2 percentage points from 2009 to 2019. Participation was highest at age 6 and declined as age increased. Children from households facing financial difficulties have a 72% lower probability of participating than other children. Over the study period, increasing poverty rates were consistently associated with lower participation. Children living in the areas with the highest poverty rates were up to 46% less likely to participate than those in areas with the lowest poverty rates. Participation in Lov'U'r Teeth has improved over the past 10 years, but the programme continues to reproduce social inequalities, as the determinants of using free preventive dental care mirror those of non-preventive care. Lov'U'r Teeth should enhance communication strategies to reach those in need and clarify the programme's benefits.

Pengaruh Financial Distress pada Trade Credit Provisions pada Perusahaan Manufaktur di BEI

Purpose: (IDX) period 2018-2023 by focusing on Financial Distress conditions on Trade Credit Provisions. Financial distress is identified through delisting conditions due to negative net income and book value and inappropriate management decisions. Methodology: Through a quantitative approach with 46 samples of companies selected based on stratified random sampling and purposive sampling methods. Results: The results of the analysis show that there is a significant negative relationship between financial difficulties and accounts payable and there is a significant negative relationship between financial difficulties and accounts receivable in the shares of manufacturing sector companies on the IDX. Limitations: The limitations of this research are only on financial distress and manufacturing sector companies 2018-2023 Contribution: It is therefore worth considering a deeper exploration of how internal mechanisms, such as working capital management and financing strategies, play a role in determining trade credit policies.

Early life social conditions and adverse experiences are associated with childhood BMI and perceived overeating.

Early life socioeconomic disadvantage and adverse experiences may lead to overeating, which is in turn associated with increased body mass index (BMI). However, recent evidence indicated that the association between childhood BMI and overeating might be bidirectional. This bidirectionality prompts the need for further investigation of early life predictors of BMI in childhood. To longitudinally assess the directionality of the association between childhood BMI and perceived overeating and to investigate their antecedent early life predictors. The sample included data from 5151 children from the ELSPAC study, collected between 18 months and 11 years of child age. The outcomes were child BMI and mother-reported overeating, assessed at the age of 3, 5, 7 and 11 years. Predictors included maternal BMI, maternal education, single parenthood, financial difficulties and adverse childhood experiences (ACEs) reported by parents and paediatricians. The random intercept cross-lagged panel model was applied. The mean child's BMI at age 3 was 15.59 kg/m2 and increased to 17.86 kg/m2 at age 11. The percentage of parent-reported overeating increased in the following period, from about 12% at age 3 to 17% at age 11. The results showed temporal stability in perceived overeating and BMI, with a bidirectional relationship strengthening over time. The child's BMI was associated with maternal BMI. Maternal BMI was positively associated with child-perceived overeating, but a stronger effect was found for ACEs. ACEs mediated the impact of maternal education, financial difficulties and single parenthood on overeating. We observed stable bidirectional associations between BMI and perceived overeating. The results indicated two main pathways: one linked to maternal BMI and early childhood BMI increase followed by perceived overeating and the second associated with ACEs mediating the effect of early childhood social factors on perceived overeating, leading to gradual BMI gain.

Solar Energy Challenges for Rural Electrification: Case Study of Lower-Shabelle Region of Somalia

Renewable energy is a promising energy source for sustainability to meet the demands of clean energy in the future and the alternative way of fusil fuels. Somalia has great potential for alternative energy sources, particularly solar and wind power. Apart from that, there are challenges related to the implementation of this alternative energy source especially solar energy for rural electrification in the Lower-Shabelle region in Somalia which can be categorized as social awareness, financial difficulties, and technical obstacles. The aim of this research is to identify and evaluate the challenges of solar energy for rural electrification in Lower-Shabelle region in Somalia, the current energy sources that have been utilized and the possible future strategies that should be in Somalia. This research project is conducted through a survey using an online questionnaire that has been distributed in Afgooye district in Lower-Shabelle region in Somalia. The statistical model of IBM SPSS version 25 was used to study the descriptive analysis of the collected data, reliability analysis and distribution test analysis. Based on the statistical analysis, the results indicated the significance impact of scattered settlement pattern of rural people in this area as 46% of respondents agreed, while 32% participants strongly agreed and 26% agreed towards the impact of traditionalway of living of rural people and dependence on conventional energy source. A significantpercentage of the respondents have shown strong agreement 39% and agreement of 34% regarding the impact of higher cost of importing off-grid solar products. Additionally, a significant number (46.1%) of them have responded with agreement on low-rate return of from solar projects in the rural areas. Furthermore, respondents recognized the effect of shortage or lack of technical knowledge of solar technologies in this region, with 38% of them in agreement and 36% agreed. Finally, respondents widely agreed about other technical related to solar technologies efficiency like battery overcharge and poor layout of solar panels where most of the respondents agreed about these challenges.

Age-Related Variation in Ecological Resources Among Veterans Seeking Treatment Related to Military Sexual Trauma.

Approximately 16% of Veterans experience military sexual trauma (MST), defined as sexual assault or harassment experienced during military service. Veterans across life stages may possess differing resources and face unique stressors that impact their ability to engage in mental health treatment or require additional liaison to services. The present study sought to characterize age-related differences in the socioecological contexts of Veterans seeking mental health treatment following MST in the domains of economic sufficiency, housing, spiritual coping, supportive relationships, and interpersonal violence. From 2009 to 2019, Veterans (N = 640) seeking mental health services following exposure to MST attended evaluation and treatment planning sessions at a Midwestern Veterans Health Administration posttraumatic stress disorder specialty clinic. Veterans completed semistructured interviews that included surveys and diagnostic screenings to assess psychosocial needs and resources. ANOVA and ordinal regressions were used to evaluate potential disparities in socioecological resources by age. No age-related differences in economic sufficiency and stable housing emerged, though most Veterans (57%) endorsed financial difficulties. Veterans who endorsed spiritual beliefs were significantly older than those who did not. Veterans who reported having a support system were significantly younger than Veterans who denied having a support system. Less than half (46%) of Veteran reported having peer relationships. Veterans who endorsed frequent interaction with their peers were significantly older than those who did not. Veterans who reported past-year exposure to interpersonal violence were significantly younger. Greater clarity about age-related differences in the socioecological contexts of Veterans can support clinicians in providing responsive mental health treatment and connecting Veterans to additional Veterans Health Administration resources following MST.

ЗАЛУЧЕННЯ ІНВЕСТОРІВ У ТЕРИТОРІАЛЬНОМУ МАРКЕТИНГУ

In the conditions of economic instability caused by the spread of the COVID-19 pandemic and military actions by the russian federation on our territory, local government authorities feel the impact of the "belt-tightening" strategy implemented by the central government. Faced with their own financial difficulties, the center reduces transfers, which were previously the main source of funds for supporting infrastructure and overall urban development. Therefore, territorial bodies aspiring to development must actively work on creating a positive image of their territory to diversify sources of capital and attract new investors. In this context, territorial marketing to attract investors is promotion (advertising). In turn, promotion is the fourth element of the implementation of territorial marketing, but it requires utilizing the entire marketing mix (the "4P" concept). When considering the first element of the implementation of territorial marketing, it is worth mentioning that many regions of our country can offer themselves to investors through so-called territories with preferential investment regimes. Thus, the task of forming the "territory for the investor" product will include two main components: the territory as a whole and territories with special regimes. To conduct pricing effectively, it is necessary to have a good understanding of investment projects and possess up-to-date information about the market. "Place" - location or placement - is the most complex and difficult concept in territorial marketing. While the placement of the territory cannot be controlled, the flow of resources passing through this territory, forming growth points, can be managed. Certainly, in business, promotion and advertising activities are more technologically advanced than in the public sector, but this is quite natural. There will be no significant differences because attracting a professional from the advertising market for government or local self-government is easier than a marketer working with the strategic block. However, if private practices and techniques are quite successful, more conceptual issues of promotion significantly lag behind. As in business, in territorial product management, it is advisable to use all available means, even if it is a small budget for advertising and a few exhibitions per year. However, marketing of territorial products, especially in attracting investors, is a complex task that is effectively solved comprehensively and sequentially, guided by the marketing mix.

Predicting Financial Failure of Public Teaching Hospitals: An Application of Fuzzy Clustering Analysis

Purpose –To develop a novel prediction model and determine the variables that best predict hospitals’ financial failures. Design/methodology/approach –A fuzzy C-means clustering analysis was conducted using financial ratios from MoH Hospitals’ financial databases. Hospital Fuzzy Financial Health Scores (HF-HFS) then were calculated the as the degree of financial failure measured through the selected n-cluster model. Findings –The results show that the number of teaching hospitals experiencing financial failure has increased. HF-FHS scores also were compared with the modified Altman Z scoresa commonly used financial distress measure in the hospital service sector. The HF-FHS scores in good and poor financial conditions differ significantly. The HF-FHS scores were also strongly correlated with the Altman Z scores. Discussion –The rising trend in the number of hospitals experiencing financial difficulties over the years may cause some hospitals in financial distress to fail to fulfill their obligations, which may disrupt the services provided. In such a situation, good management skills, which are the most important factor reducing the financial risks of hospitals, will not work after a certain point.Conclusions –The findings indicate Fuzzy C Means clustering as a viable option to evaluate the financial failure of hospitals compared to more traditional methods such as Altman Z scores. Hospitals still face financial pressures due to market and structural factors such as the global budget repayment system, pricing and collection time, and insufficient competition conditions.Predicting hospitals’ financial failures can help develop managerial policies and strategies to recognize and combat risks, improveperformance, and improve the current situation of hospitals.

Performance assessment of food safety systems (FSMSs and FSC) in water bottling factories in view of their contextual characteristics

Foodborne illnesses affect 30% of people in developed nations and lead to financial difficulties in less wealthy countries. Insufficient understanding of pathogens and inadequate food safety practices in water bottling facilities impede progress. To prevent illnesses, ensuring clean water, proper sanitation, and good hand hygiene are essential in order to decrease the 829,000 annual deaths related to diarrhea. This study aimed to evaluate the performance of food safety systems in water bottling factories in view of their contextual characteristics. A study was conducted in northwestern Ethiopia at water bottling factories from January 2023 to August 2023. This study used a mixed method approach to collect and analyze data through laboratory testing, observations, interviews, questionnaires, and document analysis. The Kruskal‒Wallis H test was used to compare mean scores of context riskiness and food safety output across four clusters, while the Mann‒Whitney U test was used to compare means between certified and noncertified factories. In our study, 43% of the samples showed positive total plate count. The result also indicated the presence of potentially dangerous by-products of chlorine, trihalomethanes was found in bottled water. On average, the manufacturers operated in a moderate risk context. Inadequate food safety outcomes resulted from lower food safety management systems scores. Factories with insufficient Food Safety Management Systems often face challenges marked by safety protocol discrepancies, leading to higher risks of contamination and non-compliance with regulations. This assessment underscores the need for tailored interventions focusing on specific contextual barriers to improve food safety outcomes in the bottled water industry.