Search Results (230)

Background: Financial sustainability remains a central challenge for U.S. hospitals as rising operating costs, shifting federal reimbursement, and policy uncertainty intensify economic pressures. This study estimates the prevalence and recent changes in financial distress among U.S. short-term acute care hospitals. Methods: We conducted a national longitudinal analysis of all U.S. short-term acute care hospitals from 2021 to 2023 using financial and operational data from Medicare cost reports linked with community-level data from the American Community Survey. Financial distress was measured using the Altman Z-score, with severe distress defined as Z ≤ 1.8. Logistic regression models were used to identify organizational, operational, and market characteristics associated with distress. Results: The proportion of hospitals classified as severely financially distressed increased from 18.6% in 2021 to 22.0% in 2023. Operating margins and returns on assets declined significantly over the study period, while mean Z-scores showed a modest but non-significant downward trend. In adjusted models, urban hospitals had higher odds of distress (OR 1.27, 95% CI 1.15–1.40, p < 0.001), as did hospitals with longer average lengths of stay (OR 1.07 per day, 95% CI 1.04–1.09, p < 0.001) and higher debt-to-equity ratios (OR 1.05 per unit, 95% CI 1.05–1.06, p < 0.001). Higher occupancy rates were protective (OR 0.31, 95% CI 0.25–0.40, p < 0.001). Larger market population was also associated with increased distress risk (OR 1.61, 95% CI 1.21–2.14, p = 0.001), while other market characteristics were not significant. Conclusions: Financial distress remains widespread and appears to be increasing among U.S. acute care hospitals. Operational efficiency, capital structure, and local market scale are key drivers of financial vulnerability, highlighting the need for targeted strategies to strengthen hospital resilience and preserve access to essential acute care services. Full article

Background: Evidence on the long-term impact of sapropterin in phenylketonuria (PKU) is limited. Understanding its effects on dietary restrictions, growth in children, and caregiver burden is essential to optimize PKU management. Methods: This prospective, two-year longitudinal study with a comparison group followed 33 children with PKU after sapropterin responsiveness assessment (21 responsive, 12 non-responsive). Outcomes included metabolic control, prescribed protein intake, dietary patterns, growth, psychological measures, and caregiver burden. Results: Sapropterin-responsive children increased natural protein intake from 10 g to 28 g/day at 2 years (p < 0.001), with reduced protein substitute intake (60 g [56–63] to 45 g [40–60], p < 0.05); no changes occurred in non-responsive children (p > 0.05). Animal-based foods (cheese, eggs, meat, fish) were introduced in 52% (11/21) of responsive children once tolerance exceeded approximately 25 g/day. The caregivers of responsive children reported reduced financial, familial-social, and personal burden (all p ≤ 0.05), alongside decreased food neophobia (p = 0.005) and caregiver depression (p = 0.013). In sapropterin-responsive children, weight and BMI z-scores remained stable, while height z-score increased over 24 months (p = 0.03); non-responsive children had higher weight and BMI z-scores than responsive children at 24 months (p = 0.037 and p = 0.026). Blood phenylalanine concentrations remained within recommended target ranges overall, with lower median values in responsive children at several time points. Conclusions: Sapropterin enabled more flexible, sustainable dietary management in responsive children with PKU, supporting metabolic control, growth, and improved family well-being and social participation. Equitable access to therapies and long-term dietetic support remain essential to optimize outcomes. Full article

The current landscape of Environmental, Social, and Governance (ESG) ratings is fragmented by methodological inconsistencies, lack of standardization, and substantial divergences among rating providers. These discrepancies hinder comparability, reduce transparency, and undermine the reliability of ESG assessments, limiting their effectiveness for both investors and corporate decision-makers. To address these issues, this study introduces a standardized approach to ESG rating construction, aimed at enhancing the objectivity and interpretability of corporate sustainability evaluations. The methodology integrates the Global Reporting Initiative standards with the United Nations Sustainable Development Goals, thereby identifying a coherent set of key performance indicators across the ESG pillars. By relying solely on publicly available data and incorporating mechanisms for managing missing information, the model provides a transparent and reproducible framework for sustainability assessment. Its validity is demonstrated through an empirical application to firms in the financial and manufacturing sectors across Europe and the United States, with benchmarking against established ratings from providers. Rather than replicating existing ESG scores, the model offers a transparent and reproducible alternative built on disclosed performance data, without relying on forward-looking statements, corporate promises, or commercial data providers. By penalizing non-disclosure and enabling sector-specific sensitivity analysis, the framework supports more accountable and customizable sustainability assessments, helping align ESG evaluations with strategic and regulatory priorities. Full article

Sustainability has become a central concern globally, and efforts to enhance it are being made across various fields. In line with this trend, corporate sustainability reports have become more widely published. These reports provide both financial and non-financial information on a company’s sustainability. In this context, this study aims to, first, analyze the key keywords contained in CEO messages. Second, it examines whether the keywords emphasized by CEOs change in response to shifts in corporate risk under economic uncertainty. Finally, it identifies how the categories of words included in these messages are classified. To address these research questions, text analysis was selected as the methodology. Specifically, a qualitative research approach using text mining and CONCOR analysis was conducted on the text from sustainability report. According to the Term Frequency and Term Frequency-Inverse Document Frequency analyses, the most frequently occurring keywords were ESG, Sustainable, Society, Stakeholders, Growth, Environment, Effort, and Future. Centrality analysis identified the following keywords as having high centrality: Sustainable, ESG, Society, Environment, Growth, Effort, and Stakeholders. Finally, CONCOR analysis revealed four clusters: Eco-friendly Energy, ESG Management, Global Crisis, and Technological Competitiveness. This study is significant in that it analyzes the major keywords and their changes within unstructured text data using text mining and CONCOR analysis, and it suggests the possibility of future quantitative analysis of non-financial information using these keywords. Full article

The loss of urban nature and declining biodiversity pose significant challenges to the sustainability of cities and the well-being of their inhabitants. Existing initiatives such as the Taskforce on Nature-related Financial Disclosures (TNFD) have begun to address ecological risks in real estate, but they still address mental health, biodiversity, and social equity only partially as non-financial values. This article adopts an integrative review and conceptual framework approach. It develops a nature-based accounting framework for urban real estate that combines principles of traditional Chinese architecture with contemporary sustainability metrics. The study reviews ecological theory, nature-related accounting, and evidence on biodiversity and mental health, and then undertakes an operational mapping from classical site planning, courtyard design, water management, and community structures to measurable indicators that remain compatible with TNFD-aligned reporting. The framework groups indicators into three main domains: nature-related conditions, ecosystem service pathways, and human well-being outcomes. It also outlines simple procedures for normalising and combining these indicators at the project scale to support assessments of biodiversity, microclimate, mental health, and basic aspects of cost-effectiveness and social accessibility in urban real estate projects. The paper provides a structured, heritage-informed basis for future applications and empirical testing, helping to incorporate biodiversity, mental health, and equity into urban real estate assessment. Full article

The Asia Pacific, led by the resource-dependent ASEAN-5, is the largest carbon contributor, yet its firms exhibit critically low transparency. This study examines the relationship between voluntary Sustainability Assurance (SA) and carbon disclosure transparency using 875 firm-year observations (2018–2022). Applying panel regression and several robustness tests, we find that SA adoption has a positive relationship with the magnitude of disclosed carbon emissions, indicating enhanced transparency. This positive relationship is significantly more pronounced in firms with high environmental performance and greater property, plant, and equipment (PPE) efficiency, suggesting SA aligns with genuine sustainability efforts rather than symbolic reporting. Furthermore, SA increases the likelihood of disclosing the complex Scope 3 emissions. However, the effectiveness of SA is conditional: its transparency benefit is statistically significant only within mandatory sustainability reporting (SR) regimes and in non-environmentally sensitive industries, highlighting crucial variations across regulatory and industrial contexts within ASEAN-5. This research provides evidence on the role of SA in emerging markets, extending Agency Theory by demonstrating its function as a credibility signal that reduces information asymmetry. We offer practical guidance for managers seeking market differentiation, and for regulators aiming to align voluntary SA with IFRS S1/S2 to enhance disclosure quality. Full article

The growing demand for transparency in sustainability reporting has compelled enterprises to look far beyond the boundaries of classical financial ratios when assessing their own performance. Environmental, social, and governance (ESG) indicators have dominated recent academic debate—primarily because of mounting regulatory and societal pressure. By contrast, the significance of other non-financial performance indicators (NFPIs), such as operational efficiency, quality management, and employee turnover, has been insufficiently explored, despite their importance for long-term competitiveness. Existing research is fragmented and provides limited integrative insights, which creates a clear gap regarding how ESG and non-ESG indicators collectively influence organisational performance. To address this gap, this study synthesises the NFPI landscape through (1) a combined bibliometric and systematic literature review, (2) detailed manual content analysis used to construct a theoretical framework integrating ESG and non-ESG indicators, and (3) expert validation to recommend a concise set of NFPIs for the manufacturing sector. Findings indicate that experts prioritise sustainability-related indicators, even when presented with a broader NFPI framework. This highlights a practical misalignment between theoretical expectations and industry focus. The study contributes a validated NFPI set and an integrative framework that aids more informed managerial decisions. Full article

Investors use information about companies’ social and environmental performance to make investment decisions, a strategy known as Environmental, Social, and Governance (ESG) investment analysis. ESG screening may offer a mechanism to incentivize corporations to improve their health impact. However, there has been limited investigation of the extent to which ESG investment frameworks capture corporate health impacts in major industries. In this study, we sought to characterize the extent to which ESG frameworks address the health-impacting activities of the food and beverage (F&B) industry. To do this, we conducted a deductive framework analysis during the period of September 2023 to March 2024. Specifically, we identified gaps in existing ESG frameworks by comparing the content of five ESG reporting standards and rating systems to the HEALTH-CORP-FB typology, an evidence-based typology that describes the health-impacting activities of the F&B industry across seven domains (Governance Practices, Political Practices, Preference and Perception Shaping Practices, Economic Practices, Employment Practices, Products and Services, and Environmental Practices). To further assess how ESG frameworks account for the health-impacting activities of the F&B industry, we classified health-focused ESG fields in the packaged foods subindustry by two attributes: relevance to the assigned HEALTH-CORP-FB activity (low, medium, high) and type of business operations addressed (e.g., process, performance). Results indicate that, on average, the ESG fields (n = 1348) covered 39% of the 89 HEALTH-CORP-FB activities (range across frameworks: 27–48%). Higher proportions of activities in the Governance, Environmental, Employment, and Economic Practices domains (range across domains: 43–87%) were represented than activities in the Products and Services, Preference and Perception-Shaping Practices, and Political Practices domains (17–36%). Fields assigned to the latter domains were also less likely to be deemed highly relevant and to measure corporate performance. We conclude that the ESG frameworks included in this study capture some of the activities of the F&B industry that affect population health and health equity; however, critical gaps remain. We discuss how integrating key health-focused ESG indicators (e.g., revenue generation from ultra-processed foods) into existing frameworks could enable investors, public health organizations, civil society, and shareholder advocates to strengthen the accountability of the F&B sector with respect to health. Full article

Environmental accounting adoption remains limited in transitional economies, particularly where formal institutions fail to enforce sustainability mandates. We examine this phenomenon in Albania—an EU candidate country with regulatory requirements but no implementation infrastructure. Drawing on institutional-void theory and resource-based perspectives, we test whether adoption mechanisms diverge when external enforcement is weak. Survey data from 151 Albanian non-financial companies, analyzed using ordinal logistic regression, show that firm size predicts adoption, whereas sector, ownership, and market orientation do not. Critically, individual-level factors—managerial environmental knowledge and pro-environmental values—significantly predict adoption, while external institutional factors exert negligible influence. Analysis of Corporate Sustainability Reporting Directive readiness reveals similar patterns: internal organizational capacities support preparation, whereas external support remains insufficient. These findings demonstrate how institutional voids shape sustainability accounting and provide empirical evidence from an understudied Balkan context. Full article

This study investigates the relationship between investor sentiment (IS) and trust in sustainability reports (TSRs) in Egypt, which is an emerging market that has recently strengthened its sustainability disclosure practices. Drawing on behavioral finance and disclosure theory, this study also examines the moderating role of financial literacy (FL) in shaping this relationship. A quantitative, questionnaire-based survey was presented to 328 individual investors who are familiar with sustainability and ESG reporting. The data were analyzed using descriptive statistics, reliability tests, and both simple and hierarchical regression analysis. The results indicate that IS has a strong and significant positive effect on trust in sustainability reports, with market optimism and emotional influence emerging as the most influential dimensions. Furthermore, the hierarchical regression results reveal that FL significantly strengthens the relationship between IS and TSR, indicating that, within the present sample, more financially literate investors translate sentiment into more informed and rational trust judgments. These findings contribute to the accounting and sustainability reporting in the literature by demonstrating that trust in non-financial disclosures is not only shaped by reporting practices but is also heavily influenced by investor psychology and financial competence. This study highlights the importance of enhancing both disclosure quality and investor financial literacy to strengthen confidence in sustainability reporting in emerging markets. Full article

Background/Objectives: A gluten-free diet (GFD) remains the only effective therapy for celiac disease (CD) and non-celiac gluten sensitivity (NCGS). Strict adherence is essential, yet it can impose considerable psychological, social, and financial burdens. This study investigated factors influencing GFD adherence, explored the perceived burden of this therapy, and examined differences between individuals with CD and NCGS. Methods: A cross-sectional anonymous questionnaire was completed by 681 Romanian citizens living in Romania with either a medically confirmed or a self-reported diagnosis of CD or NCGS. The survey assessed GFD adherence and its potential predictors, including gender, family history, comorbidities, diagnostic confirmation, and food security and perceived availability, as well as various psychological, social, and financial factors. Results: Participants with CD showed significantly higher GFD adherence than those with NCGS. Self-diagnosis was more common among NCGS respondents and was associated with poorer adherence, whereas a medically confirmed diagnosis predicted stricter adherence. Longer time since diagnosis, a greater perceived importance of a GFD, consistent label reading, as well as weight gain after starting a GFD were also positively associated with adherence. Although gluten-free (GF) food security has improved over time, cost remains a major barrier. Social activities negatively influenced adherence, reflecting the isolating effects of dietary restrictions. Nearly 25% of respondents reported a family history of gluten-related disorders (GRDs). Women—although more frequently affected by GRDs—exhibited levels of adherence similar to men. Comorbidities were common (33.9%), predominantly autoimmune diseases (56.3%), with autoimmune thyroiditis (32%) and lactose intolerance (19.2%) being the most frequent comorbidities. Conclusions: Diagnostic certainty, motivation, and practical barriers influence GFD adherence. Enhanced public awareness, clear labeling, improved GF food security, and financial support could facilitate sustained adherence and reduce psychosocial burden. To the author’s knowledge, this is the first national study of its kind in Romania. Full article

The increasing importance of sustainability reporting requires a deeper understanding of how companies communicate their sustainability efforts across regions and sectors. This study focuses on China and the United States as subjects. By analyzing corporate sustainability reports from these two major economies in 2022, it evaluates the effects of regional and sectoral differences on sustainable practices, with the aim of deepening the understanding of organizational sustainability. Using topic modeling, this study identified the key topics and patterns that companies in the two countries prioritize in their corporate sustainability reporting. A bag-of-words approach was adopted to analyze the attitudes of corporations in two countries toward environmental, social, and governance dimensions, with a focus on sector-specific differences. Finally, sentiment analysis with ClimateBERT assessed the tone of the reports. The findings reveal similarities and sector-specific differences in corporate sustainability reporting between China and the United States, as well as displaying divergent emphases on climate-related risks and opportunities. This study offers a multi-method approach to evaluating corporate sustainability reporting, contributing to a better understanding of sustainability practices in different national and industrial contexts, and offering effective guidance for actual industry regulators and stakeholders. Full article

The rapid proliferation of fintech has created unprecedented opportunities for enhancing bank credit-risk management and promoting financial sustainability. Using an unbalanced panel dataset of Chinese commercial banks spanning 2013–2023, we construct a bank-specific fintech index through text mining of annual reports combined with an entropy-weighted methodology, and systematically examine the relationship between fintech adoption and credit risk. Our empirical findings reveal that fintech adoption significantly mitigates credit risk, reducing the non-performing loan ratio by an average of 0.9 percentage points. This effect is more pronounced among non-state-owned banks and in regions with less developed service sectors. Mechanism analysis further demonstrates that financial sustainability is a critical transmission mechanism: fintech mitigates credit risk by improving both cost efficiency and asset efficiency, thereby enhancing banks’ economic resilience. Additionally, we find that regional green development is a powerful moderator that significantly amplifies the risk-reducing impact of fintech. These findings offer robust empirical evidence for guiding commercial banks’ digital transformation strategies and informing regulators’ green finance policy formulation. Our results underscore the strategic importance of fintech investment in building more resilient and sustainable banking systems. Full article

In pursuit of sustainable development goal 5 (SDG5), this study underscores gender equity and women’s empowerment as pivotal themes in sustainable development. It examines the drivers of women’s empowerment, including education, economics, finance, and legal rights, using data from $n=223$ individuals, primarily women (68.4%) aged 20–30 (69.6%). The research methodology integrates descriptive statistical measures, machine learning (ML) algorithms, and graphical representations to systematically explore the fundamental research inquiries that align with SDG5, which focuses on achieving gender equity. The results indicate that higher educational levels, captured through ordinal encoding and correlation analyzes, are strongly linked to increased labor market participation and entrepreneurial activity. The random forest (RF) and support vector machine (SVM) classifiers achieved overall accuracies of 89% and 93% for the categorization of experience, respectively. Although 91% of women have bank accounts, only 47% reported financial independence due to gendered barriers. Logistic regression correctly identified financially independent women with a 93% recall, but the classification of non-independent participants was less robust, with a 44% recall. Access to legal services, modeled using a neural network, was a potent predictor of empowerment (F1-score 0.83 for full access cases), yet significant obstacles persist for those uncertain about or lacking legal access. These findings underscore that, while formal institutional access is relatively widespread among educated women literate in the digital world, perceived and practical barriers in the financial and legal realms continue to hinder empowerment. The results quantify these effects and highlight opportunities for tailored, data-driven policy interventions targeting persistent gaps. Full article

This study aims to examine the corporate values of IBEX35-listed companies and compare them with the sustainability governance information in their Non-Financial Statements (NFSs) to identify cultural patterns indicating high sustainability governance maturity (HSGM). The study uses the Cultural Fit Assessment Method (CFAM©) based on the Competing Values Framework (CVF) and six cultural archetypes (People, Goals, Digital, Innovation, Norms, ESG). It also incorporates sector-specific indicators related to sustainability governance from the IV Comparative Report of the NFS of IBEX35-listed companies published in 2021 by Ernst and Young (E&Y). A fuzzy-set qualitative comparative analysis (fsQCA) was conducted to identify patterns of corporate culture that explain the high maturity levels of sustainability governance. The results reveal two sector-level paths to HSGM in which Digital emerges as a core presence condition and ESG appears as a core absence condition (~ESG). ESG does not emerge as a necessary condition; instead, HSGM arises configurationally. The first combination encompasses the presence of people, goals, and digital cultures, coupled with the absence of innovation, norms, and ESG archetypes, resulting in an HSGM model. The other alternative to obtaining HSGM is through a cultural combination of the absence of people, goals, and ESG cultures alongside a strong emphasis on digital, innovation, and norms archetypes. This study offers a unique approach to assessing the maturity of sustainability governance based on corporate culture. Identifying patterns of corporate culture that indicate high maturity levels of sustainability governance offers practical guidance on how organizations can enhance their sustainability practices. Full article