The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.

ESG performance and corporate financial distress: Evidence from China

Progressive gradient boosted trees for imbalanced financial distress prediction

This study presents a prospective policy analysis of healthcare workforce (human resources for health, HRH) reforms in Meghalaya, India, a state facing dual challenges of a rising burden of non-communicable diseases (NCDs) and persistent inequities in access to medical and public health specialists. Grounded in a health systems and social justice perspective, this study examines current HRH needs and proposed reforms, evaluating their potential to address the evolving health demands of the population, particularly among poor and marginalized groups vulnerable to NCDs. Using secondary evidence, including national surveys, epidemiological data, and government reports, the study maps workforce gaps, especially in rural and tribal regions, and highlights the physician-centric nature of HRH governance in India. The Walt and Gilson policy triangle, combined with adapted HRH evaluation frameworks, guided the analysis of policy context, content, processes, and actors. This approach identified key gaps in recruitment, rural retention, cadre structures, and specialist training for effective NCD prevention and management. A scenario analysis, using the Intuitive Logic method, developed a best-case trajectory of reform achievable through equity-oriented design, strong political will, and institutional capacity, while recognizing risks of policy stagnation. Findings indicate that achieving a socially accountable HRH system characterized by equitable distribution, transparent governance, and meaningful community engagement is critical for improving NCD outcomes and reducing health inequities, particularly by preventing financial distress among the poor. The study contributes to health policy and systems research by linking institutional design to future health system resilience, underscoring the need to embed justice, participation, and adaptability within HRH governance to effectively address present and future health challenges in low-resource contexts such as Meghalaya.

Grounded in Chinese healthcare and cultural background, this study aimed to develop and validate the Subjective Financial Distress Scale (SFDS) for cancer patients. Between July and November 2022, cancer patients were recruited from the oncology department of a Grade A hospital in Jiangsu Province by the convenience sampling method. This research was conducted in three stages: Phase I (Item development) included domain identification and item generation based on a systematic literature review and preliminary qualitative interview results. Phase Ⅱ (Scale development) reduced items through Delphi expert consultation, a pilot test, item analysis and exploratory factor analysis. Phase III (Scale validation) evaluated the reliability and stability of the scale. A total of 452 patients were recruited. The final scale consisted of 24 items with 6 dimensions, including financial risk perception, changes in daily consumption patterns, changes in work status, changes in treatment plans, individual spontaneous emotional experiences and externally mediated interactive reactions. The scale's Cronbach's alpha, split-half reliability, test-retest reliability and content validity were 0.949, 0.902, 0.953 and 0.970, respectively. Comparison with the Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures showed high calibration correlation validity (coefficient = 0.805). Confirmatory factor analysis showed that the first-order and second-order models both fit well, respectively. The SFDS is reliable and valid to assess the degree of the subjective financial distress in cancer patients.

Testicular cancer (TC) is the most common malignancy in young men and is highly curable with platinum-based chemotherapy. With growing survivorship rates, treatment-related symptom burden and quality of life (QoL) have become increasingly important. This study evaluates the impact of different TC treatments on symptom burden and QoL. Of 715 patients with TC and primary or postchemotherapy retroperitoneal lymph node dissection (RPLND) treated at the University Hospital Düsseldorf between 2010 and 2024, 486 eligible survivors were contacted, and 124 (25.5 %) completed a standardized questionnaire. Treatment-related symptoms, including QoL and mental health status, were assessed using the EORTC QLQ-C30 and PHQ-9 questionnaires, respectively. Results were compared with age-matched reference values from the general population. A subgroup comparison of clinical stage (CS) II patients treated with primary RPLND versus first-line chemotherapy followed by RPLND was performed to identify chemotherapy-specific effects. The median time between last treatment and survey response was 55 months. Twenty-four patients were treated with primary RPLND, 80 patients with adjuvant or first-line chemotherapy and RPLND, and 20 patients with multiple lines of chemotherapy and RPLND. Overall, TC survivors reported high global QoL scores comparable to age-matched normative data. The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy. Subgroup analysis showed that CS II patients treated with a single first-line chemotherapy reported lower social functioning and greater financial distress compared with those managed with surgery alone. Despite the physical impact, depression rates were low and similar to the general population, indicating preserved psychological well-being. TC survivors maintain good QoL comparable to the general population despite therapy-related symptoms. While persistent side effects such as polyneuropathy and tinnitus are common, their impact on QoL is limited. However, even first-line chemotherapy affects sexual health, social functioning, and financial well-being, highlighting the importance of the development of new treatment approaches and clinical studies focusing on surgery as a QoL-preserving option in selected low-metastatic cases.

ABSTRACT This research investigates how non-profit and non-financial performance affects executive compensation stickiness among Chinese A-share-listed companies in Shanghai and Shenzhen from 2009 to 2024. The findings reveal that both non-profit and non-financial performance are positively associated with compensation stickiness. Mechanistic tests indicate that non-profit performance enhances compensation stickiness by lowering financing costs and improving market expansion capabilities, whereas non-financial performance does so by lowering financing costs and enhancing corporate reputation. Heterogeneity tests demonstrate a stronger positive impact in firms with lower profit pressure, less financial distress, myopic or non-local executives, lower economic policy uncertainty, and weaker speculative culture.

Beyond affordability, financial strain can induce psychological stress and a sense of financial distress, collectively termed "financial toxicity". Although dialysis in Japan is extensively covered by public insurance, little is known about the prevalence of financial toxicity and its effects on medication adherence. This study aimed to assess the prevalence of financial toxicity and examine its association with medication adherence among patients undergoing haemodialysis in Japan. This multicentre, cross-sectional study included Japanese adults undergoing in-centre haemodialysis at six facilities. Financial toxicity and self-reported medication adherence were assessed using the Comprehensive Score for Financial Toxicity (COST) and the 12-item Adherence Starts with Knowledge (ASK-12) scale, respectively. The COST scores were compared with published data from Japanese patients with cancer and patients undergoing dialysis from other countries using unpaired t-tests. Associations between the COST and ASK-12 scores were analysed using multivariate general linear models. A mediation analysis was conducted to explore potential pathways underlying this association. In total, 455 participants were included. The mean COST score was 22.0, and 68.5% of the participants experienced at least mild financial toxicity. Financial toxicity severity was comparable to that of Japanese patients with cancer and significantly lower than that reported among patients undergoing dialysis in Brazil and China. Lower financial toxicity (higher COST scores) was associated with fewer medication adherence difficulties (per 1-point higher: β = -.17). The mediation analysis suggested that emotional impact represents one pathway linking financial toxicity to adherence difficulties. Despite generous public coverage, financial toxicity is common among Japanese patients undergoing haemodialysis and is associated with subjective difficulties in medication adherence.

Financial well-being is a key determinant of quality of life, since it reflects the individual's ability to meet current and ongoing financial obligations, feel secure about their financial future, and make choices that allow enjoyment of life. This is particularly important contexts with high inequality and uncertainty such as the case of Chile where many individuals rely on consumer credit from retail and banking institutions for monthly expenses. Therefore, having an instrument the reliably measures said variable across different sociodemographic groups, such as gender, ethnicity, and employment status is essential. This study examined the psychometric properties of the Personal Financial Wellness Scale (PFWS) among Chilean emerging adults. An adapted version of the PFWS was administered to 624 university and technical students (64.1% women), aged 18 to 29years (M = 20.44, SD = 3.35). Exploratory Structural Equation Modeling (ESEM) was used to test the factorial structure, and multigroup analyses evaluated measurement invariance across gender, ethnicity, and employment status. Results supported a two-factor model, financial distress and financial well-being, with satisfactory internal consistency and model fit. Partial measurement invariance was established across ethnicity and employment status, with changes in fit indices remaining within acceptable thresholds (ΔCFI ≤ .01, ΔRMSEA ≤ .015, ΔSRMR ≤ .030). For ethnicity, constraints on item 7 were released, and for employment status, intercepts of items 4 and 7 were relaxed. In contrast, full invariance was achieved across gender, with non-significant model comparisons (χ2(26) = 42.350, p = .023; χ2(52) = 61.946, p = .163) and stable fit indices across nested models (ΔCFI = 0.000, ΔRMSEA = 0.005, ΔSRMR = 0.013). These findings confirm that the PFWS captures essential dimensions of financial well-being in a culturally sensitive way, supporting its use as an early detection tool for financial distress and for guiding targeted interventions in socioeconomically vulnerable young adults.

ABSTRACT This study identifies entrepreneurial characteristics that function as informative indicators of resilience in Dutch small businesses. It focuses on firms facing financial distress and examines how recovery differs from persistent stagnation. Rather than equating resilience with survival, the analysis analytically distinguishes resilient recovery from persistent economic stagnation in order to isolate characteristics relevant for refining viability assessment and failure prediction models. A qualitative-led mixed-methods design is employed, combining semistructured interviews with 24 entrepreneurs, validated psychological and behavioral instruments, nonparametric statistical tests, and fuzzy-set qualitative comparative analysis. The findings indicate that higher levels of entrepreneurial self-efficacy and timely, solution-oriented responses to crisis distinguish resilient recovery trajectories from stagnation. Background characteristics, effectual behavior, and network support do not emerge as independent differentiators. Overall, the results suggest that resilience in distressed small businesses is shaped primarily by adaptive psychological and behavioral capacities rather than static attributes. These findings provide a refined basis for integrating nonfinancial indicators into small business viability assessment and failure prediction practices.

PurposeThis study examined the use of personal and social resourcefulness when experiencing anger, anxiety, sadness, decision-making, and financial distress among adult-child and spousal caregivers of persons with dementia.MethodsBaseline data on 10 Resourcefulness Scale© items measuring personal and social resourcefulness in response to anger, anxiety, sadness, decision-making, and financial distress were obtained from 127 adult-child and 112 spousal caregivers of persons with dementia.ResultsAdult-child and spousal caregivers similarly used personal resourcefulness for financial distress (62%-68%) and both personal and social resourcefulness when angry (67%), sad (87%-92%), and making decisions (77%-98%). Spousal caregivers used both personal and social resourcefulness when anxious (37%), while adult-child caregivers used only personal resourcefulness (46%). The findings were similar across age, race, and gender subgroups.ConclusionsFuture research should explore the effects of other situational factors (e.g., caregiving burden) on resourcefulness. Gerontological healthcare professionals should assess the caregiver-care recipient relationship when determining and tailoring interventions.

This study investigates the role of symmetric probabilistic models in predicting financial distress in the automotive industry, with a focus on companies operating in the Slovak Republic. Financial distress prediction represents a binary classification problem characterized by an inherent symmetry between healthy and distressed firms. To capture this structure, two widely used symmetric models—logit and probit—are applied and systematically compared. The modeling framework incorporates LASSO regression for variable selection, enabling dimensionality reduction while preserving the most informative financial indicators. The empirical analysis is conducted on a dataset of 351 manufacturing enterprises. The results indicate that both models achieve comparable predictive performance, with the logit model reaching an accuracy of 78.9% and the probit model 77.8%. The area under the ROC curve further confirms the strong discriminatory power of both approaches. The findings highlight that the symmetric nature of the applied link functions contributes to model stability, interpretability, and balanced classification behavior. This study extends existing research by explicitly linking symmetry concepts with financial distress prediction in a sector-specific context. The proposed approach provides a transparent and practically applicable framework for early risk identification in industrial enterprises.

This study aims to examine the effect of financial distress and audit report lag on the integrity of financial statements in banking sector companies listed on the Indonesia Stock Exchange during the 2020–2025 period. The integrity of financial statements is an important aspect in presenting financial information that is reliable, relevant, and trustworthy for users of financial statements. Financial distress conditions and audit report lag are assumed to influence the quality and integrity of a company’s financial statements. This study employed descriptive and verificative methods with a quantitative approach. The sampling technique used purposive sampling, resulting in a sample of banking companies that met the research criteria. The data used were secondary data in the form of financial statements and annual reports obtained from the official website of the Indonesia Stock Exchange and related company websites. The data analysis method used multiple linear regression analysis with the assistance of SPSS software. The results of the study indicate that financial distress has no significant effect on the integrity of financial statements. This finding suggests that a company’s financial difficulties do not directly affect the integrity of financial statements because companies are still required to prepare financial statements in accordance with accounting standards and regulatory provisions. Furthermore, audit report lag also has no significant effect on the integrity of financial statements. The length of the audit process does not necessarily reflect low integrity of financial statements, but may indicate the auditor’s level of prudence in examining the company’s financial statements. Therefore, the integrity of financial statements in the banking sector is more influenced by regulatory compliance, the quality of internal supervision, and the implementation of good corporate governance.

This study aims to examine the effect of business risk, financial distress, and investment policy on firm value at PT Astra International Tbk during the period 2015-2024. Firm value in this study is measured using Price to Book Value (PBV), while business risk is measured by the Degree of Operating Leverage (DOL), financial distress by the Altman Z-Score,and investment policy by total asset growth (Asset Growth). The research employs an explanatory research design with a quantitative approach. Data analysis is conducted using descriptive statistics, classical assumption tests, and multiple regression analysis with the assistance of SPSS software. The results indicate that partially,only financial distress has a significant effect on firm value, whereas business risk and investment policy do not have a significant effect on firm value. However,simultaneously,business risk, financial distress, and investment policy have a significant effect on firm value. The coefficient of determination (adjusted R2) is 69.8%, indicating that these variables are able to explain 69.8% of the variation in firm value, while the remaining 30.2% is influenced by other factors outside the research model

This study aims to develop an early warning system to detect potential financial distress at PT Garudafood Putra Putri Jaya Tbk using Machine Learning (ML) algorithms. A quantitative case study approach was applied using the company’s publicly available quarterly financial reports from 2019 to 2024. Five ML algorithms were tested: Logistic Regression, Random Forest, Naive Bayes, K-Nearest Neighbors (KNN), and Support Vector Machine (SVM). The Random Forest algorithm achieved the highest accuracy of 85.71%, with a precision of 100%, recall of 66.67%, and an F1-score of 80%. Operating Profit Margin and Debt to Asset Ratio were identified as the most significant indicators in detecting financial distress. The proposed model can serve as a decision-support tool for management, investors, and regulators to proactively anticipate financial problems and reduce bankruptcy risk through early intervention. Keywords: Abstract, aim, scope, result

Disentangling multi-modal fusion for financial distress prediction with multi-level attention mechanisms

Association between financial distress and levels of discomfort and incapability after musculoskeletal injury.

BackgroundBurnout among healthcare workers (HCWs) is a growing concern as it has reached global levels. Despite the various crises that have afflicted Lebanon since 2020, there is a shortage of recent data regarding burnout among HCWs in the country.AimsThis study assessed burnout levels and financial well-being among HCWs in Lebanon and identified associated risk factors.MethodsThis is a cross-sectional multicentre study conducted in Lebanon. It included 907 HCWs, comprising medical students, registered nurses, physicians and postgraduate trainees. Burnout was measured using the Copenhagen Burnout Inventory and financial distress using the Incharge Financial Distress/Financial Well-being scale. Multivariable logistic regression analysis was used to identify associated factors.Results69.2% of HCWs were at moderate/high risk of burnout, with 76% susceptible to personal burnout, 73% to work-related burnout and 56% to patient-related burnout. Factors reducing burnout risk included age over 50, better financial well-being, higher income and being a person who has never smoked or a former infrequent alcohol consumer. Higher burnout risk was linked to widowhood, public sector employment, long work hours, stressful workplaces, migration intent, psychiatric history and current alcohol consumption.ConclusionBurnout risk among HCWs in Lebanon is high, necessitating urgent measures from the public health authorities to improve HCWs’ mental well-being.

Background: Endometriosis is a chronic condition associated with substantial healthcare costs, diagnostic delays and long-term impairment in quality of life. Despite the recognized economic burden, patient-reported financial distress remains insufficiently studied. The aim of this study was to adapt and validate the Polish version of the Comprehensive Score for Financial Toxicity (COST-FACIT) for use in women with endometriosis, as well as to examine demographic and clinical factors associated with financial toxicity. Methods: A cross-sectional study was conducted among Polish women with endometriosis using an online survey. The COST-FACIT was adapted following standard forward–backward translation procedures, with FACIT approval. Psychometric evaluation included internal consistency, construct validity, convergent validity with the Financial Well-Being Scale, and test–retest reliability. Exploratory and confirmatory factor analyses were performed, and multivariable models were used to identify factors associated with financial toxicity. Results: The adapted scale demonstrated good psychometric properties, with excellent internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.92) and strong test–retest reliability (r = 0.87). Exploratory factor analysis supported a two-factor structure of the instrument. COST-FACIT scores were strongly correlated with financial well-being (r = 0.78). Higher education, stable employment and higher income were associated with better financial well-being, whereas longer symptom duration, greater distance to care and higher healthcare expenditures were associated with worse scores. Conclusions: The Polish COST-FACIT demonstrated good psychometric properties and may serve as a useful instrument for assessing financial toxicity in women with endometriosis. The results highlight the financial burden of the disease and support the use of patient-reported measures to identify individuals at risk of financial distress and reduced quality of life. This tool may facilitate clinical research and improve patient-centered care.

Frailty has emerged as a significant predictor of health outcomes. However, multidimensional frailty among middle-aged and older patients with newly diagnosed breast cancer remains understudied. Therefore, this study aims to investigate the prevalence of preoperative multidimensional frailty and its associated factors in this population. A total of 223 middle-aged and older patients with breast cancer were recruited from the breast surgery ward of a general hospital in China from September 2023 to July 2024. Sociodemographic characteristics, clinical information, biochemical indicators, Tilburg frailty indicator scores, physical activity scale for the elderly scores, and Resnick exercise self-efficacy scale scores were collected from all patients. Chi-square tests and independent samples t-tests were used for univariate analyses, and variables with statistical significance were included in a binary logistic regression to identify factors associated with multidimensional frailty. The prevalence of preoperative multidimensional frailty was 36.3% in middle-aged and older patients with newly diagnosed breast cancer. Factors associated with multidimensional frailty included higher exercise self-efficacy (OR = 0.760, p = 0.004), high self-perceived financial distress (OR = 3.996, p = 0.009), living alone (OR = 17.822, p = 0.007), difficulty falling asleep (OR = 2.858, p = 0.005), ≥ 2 comorbidities (OR = 7.995, p = 0.003), low white blood cell count (OR = 5.202, p = 0.011), and overweight or obesity (OR = 0.417, p = 0.014). The prevalence of preoperative multidimensional frailty is relatively high among middle-aged and older patients with newly diagnosed breast cancer and is associated with exercise self-efficacy, self-perceived financial distress, living arrangement, difficulty falling asleep, number of comorbidities, white blood cell count, and body mass index. Healthcare professionals should assess patient characteristics to identify high-risk patients preoperatively and consider developing targeted interventions to enhance exercise self-efficacy, which may be beneficial for the management of multidimensional frailty and related health outcomes.