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Economics of hypothalamic obesity in patients with craniopharyngioma and other rare sellar/suprasellar tumors
No full textAbstract
Background
Rapid and abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment-related damage to the hypothalamus, is called acquired hypothalamic obesity (aHO), and is often linked to craniopharyngioma and/or sellar/suprasellar tumors. Here, we examine the healthcare resource use (HCRU) and costs of aHO following treatment of these tumors.
Methods
We used a retrospective matched cohort design with German statutory health insurance data on 5.42 million people from 2010 to 2021. We applied a novel three-step approach using diagnostic and prescription data to identify patients with treatment- or tumor-related (TTR)-aHO. We measured HCRU and costs across hospitalizations, outpatient visits, visits per specialist group, and outpatient prescription medications.
Results
Compared to non-HO obesity, TTR-aHO is associated with increased hospitalizations, increased outpatient physician visits, and increased prescription use in the two years after incident tumor surgery/radiotherapy. Excess costs of TTR-aHO are €19,900 per patient in the first year and €10,700 in the second, driven by inpatient costs. Cost-intensive hormone replacement therapies like somatropin lead to a sharp increase in prescription costs in the second year.
Conclusions
This study provides the first real-world analysis of TTR-aHO economics, emphasizing the importance of HCRU and costs for decision-making. Previously, economic evaluations have been missing due to the lack of a standard method to identify patients with aHO in retrospective studies. Using a new identification approach, the study reveals that TTR-aHO poses a significant burden in extensive treatment requirements for patients and high related costs for the healthcare system
Socio-Environmental Crises and Cognitive Ageing. Exploring the Cognitive Impact of the COVID-19 Pandemic and Climate Crises on Older Adults’ Memory and Verbal Fluency
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Socio-environmental crises such as the ones induced by the COVID-19 pandemic and ongoing climate change significantly impact individual health, not only but especially at older ages. While the health effects of COVID-19 lockdowns and the cardiovascular risks posed by climate change (especially heat waves) in the older population have been studied, their differential impacts on cognitive functioning in later life remain less understood, despite their relevance for the sociology of age(ing). This article thus explores the “cognitive impact” of socio-environmental crises by addressing two questions: (1) How does cognitive functioning change from the prepandemic to the postlockdown phase, and how does this compare with baseline cognitive changes? (2) How are average and peak summer temperatures linked to cognitive change over a 2-year period? Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we analysed cognitive changes in a sample of adults aged 50+ in Germany from 2004 to 2022. Random effects change score analysis focused on two cognitive measures: memory and verbal fluency. Results show that COVID-19–related cognitive decline in memory is significantly greater than baseline change rates of cognitive decline, but no such effect was observed for verbal fluency. Higher average summer temperatures are associated with faster declines in memory and verbal fluency, while peak summer temperatures are not correlated with cognitive functioning. While the social and biological mechanisms behind such changes still need to be disentangled scientifically, the sociopolitical need for action during times of polycrises is unquestionable. @Sozial-ökologische Krisen, wie sie durch die COVID-19-Pandemie sowie den fortschreitenden Klimawandel hervorgerufen werden, haben signifikante Auswirkungen auf die individuelle Gesundheit – nicht ausschließlich, aber insbesondere im höheren Lebensalter. Während die gesundheitlichen Folgen pandemiebedingter Lockdowns sowie die kardiovaskulären Risiken klimatischer Extremereignisse (insbesondere Hitzewellen) für ältere Bevölkerungsgruppen bereits empirisch untersucht wurden, ist über ihre differentiellen Effekte auf die kognitive Leistungsfähigkeit im höheren Lebensalter bislang wenig bekannt – obwohl diese für eine Soziologie des Alterns von zentraler Relevanz sind. Der Beitrag untersucht daher den „kognitiven Einfluss“ sozial-ökologischer Krisen und adressiert zwei Fragestellungen: (1) In welcher Weise verändert sich die kognitive Leistungsfähigkeit von der präpandemischen zur post-lockdown-Phase – und wie sind diese Veränderungen im Vergleich zu altersnormativen kognitiven Verläufen einzuordnen? (2) In welchem Zusammenhang stehen durchschnittliche oder maximale Sommertemperaturen mit kognitiven Veränderungen über einen Zeitraum von zwei Jahren? Anhand von Längsschnittdaten des Survey of Health, Ageing and Retirement in Europe (SHARE) werden kognitive Veränderungen bei in Deutschland lebenden Personen ab 50 Jahren im Zeitraum von 2004 bis 2022 untersucht. Um Change Scores in zwei kognitiven Indikatoren, Gedächtnisleistung und verbaler Funktion, zu untersuchen, werden Random-Effects-Modelle verwendet. Die Ergebnisse zeigen, dass pandemiebedingte kognitive Einbußen in Gedächtnisleistung signifikant über alterstypische Veränderungen in einem Zeitraum von zwei Jahren hinausgehen, während für verbale Funktion kein vergleichbarer Effekt nachweisbar ist. Höhere durchschnittliche Sommertemperaturen sind mit beschleunigten Einbußen in beiden kognitiven Bereichen assoziiert, während Maximaltemperaturen nicht mit kognitiven Veränderungen korrelieren. Auch wenn die sozialen und biologischen Wirkmechanismen hinter diesen Befunden noch zu ergründen sind, ist die gesellschaftspolitische Handlungsnotwendigkeit im Kontext multipler Krisen deutlich
The extractive business model of private equity firms in the German healthcare sector and the crisis in social reproduction
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The paper explores the contradiction between the extractive business model of the private equity buy-outs of the German healthcare sector and the crisis of reproduction, which has the potential not only to undermine the solidaristic healthcare system, but also to undermine the idea of societal protection as the object of socio-economic governance. Drawing on the insights of the international/comparative political economy and feminist literature opens an analytical space to connect the macro-financialized economy to the non-economic sphere of social reproduction and, in the process, uncover the contradictory nature of this relationship. From the vantage point of the financial crisis of 2007, the private equity industry was the beneficiary of the consecutive switch of major central banks to unconventional monetary policy and exceptionally low interest rates swamping the market with liquidity. Private equity managers and their shareholders are the big winners due to their extraordinary financial power, but this has dire consequences for the (mostly female) staff, the patients, and the wider solidaristic healthcare community. Moreover, since private equity firms operate through complex and opaque international holding structures, these entities have little to fear from German national regulatory powers to ban or prohibit tools of financial engineering such as debt push-down, asset stripping, and tax evasion; this creates a high level of uncertainty as to the impact of PEs on the sustainability of the German social market economy as a whole.B54;B59;D60;E00;E52;G23;I1
Power contestation and regulation in digital platform ecosystems - The case of the EU’s Digital Markets Act
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In this study, we investigate how power contestation between complementors and powerful platform owners unfolds in digital platform ecosystems as they come under regulatory scrutiny. Platform owners like Alphabet/Google, Apple, Amazon, and Meta/Facebook dominate their respective ecosystems, leveraging network effects and market power to maintain their positions, giving them a powerful advantage vis-à-vis supply-side complementors. Complementors have become increasingly dependent on these platforms and struggle due to their weakened position. In the EU, the European Commission has implemented the Digital Markets Act, which aims to increase fairness and contestability within and across digital platform ecosystems. Using a case study approach, we analyze how regulatory scrutiny, such as the Digital Markets Act, has affected power contestation between platform owners and complementors. In particular, we investigate app store and search platform ecosystems. We establish a conceptual framework of power contestation that shows how complementors and platform owners interact directly and through the regulator as a mediator, vying for power in the ecosystem. We thereby contribute to the emerging Information Systems literature on power dynamics and the regulation of digital platform ecosystems.L500;M15
The Future of Data Management: A Delimitation of Data Platforms, Data Spaces, Data Meshes, and Data Fabrics
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As traditional data management approaches increasingly become barriers to innovation, emerging modern approaches such as data spaces, fabrics and meshes provide much-needed flexibility. To demonstrate the potential of these modern approaches, we conducted a structured literature review and comparative analysis of 189 contributions to explore the differences between data platforms, data spaces, data fabrics and data meshes, highlighting their unique advantages in terms of governance mode and application area. Throughout our delimitation, the study reveals that data platforms and data fabrics offer centralized structures, ensuring control, accessibility, and streamlined management while decentralized data meshes and data spaces prioritize flexibility. We provide a data management matrix that provides valuable insights for organizations seeking to optimize their data management strategies in the sharing economy
From Awareness to Action: Do Decision-Makers’ Mindsets Shape Circular Economy Adoption in German SMEs?
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The transition toward a circular economy (CE) entails considerable challenges and opportunities for small and medium-sized enterprises (SMEs), particularly within the manufacturing sector. This study examines how decision-makers’ perceived benefits, conceptual understanding of the CE, and structural firm characteristics shape the adoption of CE strategies. Based on a standardized survey of 380 German manufacturing firms—283 of which qualify as SMEs—the findings indicate that structural or “hard” factors such as company size and revenue are more strongly associated with the implementation of CE practices than cognitive factors alone. While CE understanding contributes to engagement, firms with larger financial and organizational capacities are significantly more likely to operationalize circular approaches. Moreover, smaller firms express a pronounced need for external support during the transformation process. The results highlight the importance of aligning policy instruments not only with awareness-building but also with the various constraints SMEs face by establishing enabling framework conditions and stimulating markets accordingly in order to enable effective and widespread CE integration
Do the Sentiments of Forecasters Help Predict Recessions? Evidence from Germany
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This study presents an examination of the predictive power of narrative reports from German economic institutes beyond traditional quantitative forecasts in anticipating economic recessions and directional changes in the business cycle. I transform qualitative narratives into quantitative sentiment scores using four different dictionaries and methods and use fixed-effect logistic regression to analyse their impact. To evaluate model performance, I use the Area under the Receiver Operating Characteristic Curve (AUROC) to compare models with versus without sentiment scores. Additionally, I employ DeLong’s test and bootstrapping to test the significance of AUROC improvements. Furthermore, I explore the potential of combining multiple sentiment scores to enhance forecasting accuracy. The results show that sentiment scores significantly enhance forecasting accuracy. This suggests that narrative information provides valuable insights beyond quantitative forecasts alone.C33;C53;E32;E3
Beyond sentiment analysis of online customer reviews: an approach to automated measurement of technology acceptance from online customer reviews
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Recent developments in machine learning (ML), especially transformer-based discriminative and generative deep learning, transform the marketing landscape. So, e.g., marketers predict with high accuracy sentiment scores from online customer review (OCR) comments in natural language and gain valuable insights whether, when, and how apps, products, or services should be improved. However, oftentimes, OCR comments contain additional interesting information that goes beyond sentiment indications. In this work, we propose a new approach to predict – based on the well-known Technology Acceptance Model (TAM) – extended TAM construct scores from OCRs and compare the accuracy of this prediction with various ML models for this purpose. The comparison is based on a dataset with n = 5,356 OCR comments for the Ikea app, labeled by three human experts ( n = 3), and 18 ML models. Following this we conduct a case study on the Ikea dataset and show how to use these TAM construct scores in conjunction with topic modeling to identify various usability issues of the Ikea app. Additionally, we propose an approach that leverages TAM constructs to identify OCRs with complex and rich content that would not be identifiable with sentiment alone
Towards a Data-Driven Organisation: Making Data a Strategic Knowledge Asset in SMEs
No full textAbstract
Demographic shifts in organisations create an urgent knowledge management challenge: as experienced employees retire, their specialised knowledge must transfer to younger workers. This transition drives small- and medium-sized enterprises (SME) to move from intuitive to data-driven decision-making. We examine how SMEs can leverage data as a strategic knowledge asset during this transformation. Drawing from knowledge-based theory and analysing insights from 200 companies, we develop a practical framework for SMEs’ data-driven evolution. Our research identifies three critical transformation phases: recognising data’s value, building data capabilities, and integrating data into knowledge management. We derive six actionable principles that help SMEs balance structure with adaptability: (1) identifying data’s strategic potential, (2) managing data as a core resource, (3) developing specialised talent, (4) creating efficient coordination mechanisms, (5) nurturing emergent strategies, and (6) implementing flexible data strategies. These principles offer SME managers practical guidance while contributing to academic understanding of data-driven organisations. Our framework particularly helps resource-constrained SMEs navigate their data transformation journey efficiently. Future research should validate these principles quantitatively across different knowledge-intensive sectors
Divergence in Labour Force Growth in Open Economies: Should Wages and Prices Grow Faster in Germany?
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We develop a model which shows that wages, prices, and the real per-capita income should grow more rapidly in open economies with low labour force growth. Otherwise, their trade partners experience rising unemployment and/or trade deficits. We apply this framework to Germany, which has exhibited modest labour force growth, except at the moment of reunification. Goods being differentiated by country of origin (Armington’s hypothesis), low labour force growth limits German production and should lead to rising prices and wages relative to other countries. This mechanism is magnified by the low price elasticity of demand for German goods. Hence, German wage moderation could constrain other countries’ policy options. Simulations using an extended version of the model suggest that (i) disparities in labour force growth have had a significant impact on unemployment within the Eurozone, potentially contributing to the severe economic crisis faced by Southern European countries between 2010 and 2015, and (ii) the demographic shock following reunification could explain a large part of the German economic challenges from 1995 to 2005.E24;F16;J11;J21;O5