The observation took place on 10 August 2022 between 13:53 and 13:57 local time, just ten metres from a sandy beach on Læsø, an island of 118 square kilometres in the Kattegat where adders are commonly encountered. The setting was a dirt road crossing open grassland with heather on sandy substrate, dotted with scattered human habitations. The observer, KB, first noticed the adder examining the hare and biting its left hind leg.

The leveret lay on the ground, moving its four legs jerkily and its head with difficulty, clearly unable to stand. When the snake was disturbed by the observer's presence, it slipped into the tall grass, only to return within seconds and resume its inspection, focusing especially on the hare's front legs and head. Over the following minutes the adder repeated this pattern several times.

Each time the observer moved around, the snake retreated into the vegetation, and each time it came back within about twenty seconds to continue its careful and energetic examination. It then bit and pulled a front leg, and subsequently also bit the hare's head. By this point the hare was still breathing but moving considerably less than before.

What makes this record particularly valuable is the light it sheds on how adders evaluate prey. Experiments by Forsman and Lindell in 1993 showed that when an adder is confronted with a large prey item, it assesses its size by moving its snout over the body and then pushing and pulling it. The behaviour recorded on Læsø corresponds remarkably well with this experimental description.

After such an examination, an adder may either attempt to swallow the oversized prey or refrain from doing so. The authors of the new report consider it likely that the Læsø female would ultimately have abandoned her excessively large meal after careful examination, though whether she would actually have attempted to swallow the leveret had the observer not intervened remains an open question. The size estimates underlying the story are grounded in published morphometric data.

The adder's total length and body mass were roughly estimated at 60 centimetres and 110 grams respectively, based on comparisons with the surrounding vegetation visible in the videos and on the knowledge that female Common European Adders generally attain total lengths of 60 to 65 centimetres, seldom more than 70, and typically weigh 100 to 110 grams after giving birth. The hare's dimensions were estimated at 30 centimetres and 1,000 grams, drawing on extensive morphometric data for the European hare published by Zörner in 1981. Adult hares range from 2,500 to 6,500 grams, with a maximum of 8,000 grams, and reach full size after four to six months, while newborn leverets weigh approximately 100 to 150 grams.

The observed leveret's age was estimated at about three months. Notably, the female adder appeared to be in poor nutritional condition, probably having recently given birth. Attacks on oversized prey are not unknown among snakes, but cases in which the prey is killed and then abandoned because it simply cannot be swallowed remain poorly documented in the scientific literature.

A comprehensive review by Kornilev and colleagues in 2023 compiled 101 publications describing at least 143 cases of snake mortality associated with the ingestion or attempted consumption of injurious prey. Oversized prey accounted for 40.6 percent of these cases, with reptiles and fish making up 33 and 26 percent respectively, while mammals represented only 16 percent. Other examples reinforce the pattern.

On the island of Shedao off northeastern China, small Gloydius shedaoensis pit vipers frequently kill birds larger than they themselves can swallow, and larger individuals of the same species later scavenge the carcasses, a remarkable system in which oversized kills serve a communal function. Large vipers also kill raptorial birds that pose little or no threat to them, behaviour that reduces predation risk for smaller individuals. On Guam, the introduced brown treesnake, Boiga irregularis, has had a devastating impact on native Micronesian Starlings, with nearly half of ingestion attempts on fledgling birds failing because the prey was too large, and every one of those oversized fledglings was killed regardless.

Perhaps the most extraordinary parallel comes from southern Africa, where two species of spitting cobras, Naja mossambica and Naja nigricincta nigricincta, frequently enter houses at night and bite sleeping humans, normally on the hands or feet. These bites are interpreted as genuine predatory attacks, probably triggered by the smell of mammals rather than by snakes merely seeking warmth or being accidentally rolled onto. The human victims weigh between ten and thirty times the mass of the cobras, making them, in effect, vastly oversized prey.

Closer to the Læsø case, snakes have been recorded fatally overestimating their abilities with leporid prey: a gopher snake, Pituophis catenifer, and a Ladder Snake, Zamenis scalaris, both attacked young rabbits and died in the attempt to swallow them. In one documented case, a dead Common European Adder with a total length of just over 40 centimetres was found having just swallowed a large Field Vole whose mass, at 26 grams, amounted to 92.9 percent of the snake's own body mass after the prey was removed.

Subject of Research: Predatory attack by a Common European Adder on an oversized young hare in Denmark

Article Title: Overly optimistic adder, Vipera berus (Linnaeus, 1758), killing and intending to swallow an oversized young hare, Lepus europaeus Pallas, 1778

Article References: Bringsøe, H., Jablonski, D., & Birch, K. (2025). Overly optimistic adder, Vipera berus (Linnaeus, 1758), killing and intending to swallow an oversized young hare, Lepus europaeus Pallas, 1778. Herpetozoa, 38, 155-159. https://doi.org/10.3897/herpetozoa.38.e143850

Image Credits: AI Generated

DOI: 10.3897/herpetozoa.38.e143850

Keywords: Vipera berus, Common European Adder, Lepus europaeus, European hare, oversized prey, snake predation, Denmark, Læsø, Herpetozoa, envenomation, snake feeding ecology, reptile behaviour

Researchers recruited 214 participants and compared their responses on the nine-item Problem Gambling Severity Index, or PGSI, with data from 2,090 people matched by age and gender to a recent Danish national gambling survey. The PGSI ranges from 0 to 27 and classifies responses as non-problem gambling, low risk, moderate risk, or problem gambling at scores of 8 or above, a category considered indicative of gambling disorder. Almost half of the patients reported gambling in the past year, but harmful gambling was concentrated among a smaller group.

Overall, 30% of forensic psychiatric patients had a PGSI score above zero, including 8% classified as low risk, 10% as moderate risk and 12% as problem gamblers. Among the 98 patients who had gambled, 66% met the study’s definition of gambling problems at some level, and 27% reached the problem-gambling threshold. The general-population comparison showed a different pattern: past-year gambling was slightly more common in the matched sample, at 54% versus 46%, while the overall distribution of PGSI risk levels differed significantly between the groups.

Clinical records suggested that gambling disorder was seldom identified despite the survey results. A meta-analysis cited by the researchers estimated problem-gambling prevalence of 8.7% among people with psychotic disorders, compared with 12% in this forensic psychiatric sample, although the study said broader evidence on overlapping conditions could help contextualize the elevated rate. Among patients who had gambled, the researchers divided the group according to PGSI score, comparing 50 lower-risk participants with scores of 2 or less against 47 higher-risk participants with scores of 3 or more; one of the 98 gamblers lacked PGSI data.

Higher-risk gambling was associated with being male, reporting weaker financial conditions, and reporting an urge to commit crime because of gambling. All 10 patients who said they had felt compelled to engage in criminal activity during the past year were in the higher-risk group, equivalent to 21% of that group, while no lower-risk patient reported such an urge. The cross-sectional design cannot establish whether gambling contributed to offending or whether other factors influenced both gambling severity and reported criminal intent.

Spending and financial indicators also separated the two risk groups. No lower-risk patient reported spending more than 1,000 Danish kroner, approximately 184 euros, on gambling in the previous month, whereas 42% of higher-risk patients did. Higher-risk patients were more likely to have consumer loans, with 42% reporting current loans compared with 21% of lower-risk gamblers, and less likely to set aside money each month, at 41% versus 76%.

Monthly income did not differ significantly between the groups. The authors said these patterns were concerning because financial stability is important to recovery and rehabilitation in forensic psychiatric populations, but the survey did not establish a causal relationship between gambling severity and the reported financial conditions. Some higher-risk patients were already taking steps to limit their gambling.

National gambling self-exclusion services were being used by 47% of higher-risk gamblers, compared with 12% of lower-risk gamblers, and 53% of the higher-risk group reported gambling problems before entering forensic psychiatric care. Yet fewer than three patients had ever sought help from forensic psychiatry staff for gambling, and only nine of the 214 participants reported ever seeking gambling help of any kind. In another indication of possible receptivity, 67% of higher-risk gamblers requested personalized normative feedback after completing the PGSI, compared with 36% of lower-risk gamblers.

The study did not test an intervention, so it cannot establish whether such feedback changes gambling behavior or clinical outcomes. Online gambling was prominent in the findings. It was the only gambling modality used by 61% of patients who gambled, while another 16% used both online and offline channels; slot machines were the most frequently reported online activity.

The study’s broader context was Denmark’s liberalized gambling market, in which licensed online operators and growing access to offshore gambling have expanded opportunities to wager. The authors also noted that forensic psychiatric patients have internet access even in medium-secure units. These features make online and institutional contexts relevant to further investigation, but the survey did not establish that online availability, institutional conditions or other environmental factors caused the elevated prevalence.

Several limitations constrain how widely the results can be generalized. Although 486 eligible people were invited, 214 participated, a participation rate of 44%, while 56% declined. Another 105 patients who were considered too unwell or otherwise unable to complete the survey were excluded, and no non-responder analysis was possible under data-protection constraints.

The findings also relied on self-report and therefore may be affected by social-desirability bias and the assistance some participants required. Gambling was reported more often by people who completed questionnaires independently, although their mean PGSI scores and distribution of risk categories did not differ significantly from those who received assistance. The cross-sectional design, multiple comparisons, wide confidence intervals around some estimates, and differences between countries in gambling regulation and forensic psychiatric practice mean that the observed associations require replication with longitudinal designs and diagnostic interviews.

Within those limits, the study identifies a clear mismatch between survey-based gambling severity and formal clinical recognition. One in eight participants met the PGSI threshold for gambling disorder, yet gambling disorder was seldom recorded in the diagnostic data available to the researchers. The findings support further evaluation of systematic assessment, staff training and tailored treatment in forensic psychiatric settings, while the cross-sectional evidence does not show that these measures improve care, recovery or recidivism outcomes.

Whether gambling is associated with subsequent offending, how institutional environments shape gambling behavior, and which interventions are effective remain open questions for prospective research.

Subject of Research: Prevalence and correlates of gambling problems among forensic psychiatric patients in Denmark

Article Title: Prevalence and correlates of gambling problems among forensic psychiatric patients: evidence of elevated rates from a multi-site study

Article References: Eriksen, J. W., Sørensen, L. U., Kristiansen, S., Terkildsen, M. D., Hansen, R. M., Marcussen, T., Brandt-Christensen, M., Storgaard, A., Wellnitz, K. B., & Frostholm, L. (2026). Prevalence and correlates of gambling problems among forensic psychiatric patients: evidence of elevated rates from a multi-site study. Frontiers in Psychiatry, 17, Article 1931287. https://doi.org/10.3389/fpsyt.2026.1931287

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1931287

Keywords: gambling disorder, forensic psychiatry, problem gambling, cross-sectional study, severe mental illness, PGSI, Denmark, online gambling, financial hardship, criminal intent, Prevalence, correlates

The research focuses on the GAME House concept, developed by the Danish NGO GAME, which was founded in 2002 to promote sport, physical activity and social inclusion through street sports and urban culture. GAME opened its first purpose-built street sport facility in a former tram depot in central Copenhagen in 2010. Between 2016 and 2018, three more GAME Houses opened in the regional cities of Esbjerg, Viborg and Aalborg, each housed in a transformed industrial building and run under long-term agreements between GAME Denmark and the local municipality. These hybrid indoor-outdoor facilities host skateboarding, parkour, street basketball, bouldering, dance, graffiti art and music production, and they stay open almost year-round, including on traditional closing days such as Christmas and Easter.

Signe Højbjerre Larsen and Evald Bundgaard Iversen, the study’s authors, analyzed documents, construction plans and operational agreements for the three facilities, and interviewed twelve user groups with formal collaborations, the three facility managers, and consultants and directors from the municipal Culture and Leisure Departments. Their analytical framework comes from Mark Moore’s theory of public value, in particular his strategic triangle, which holds that publicly funded organizations sustain themselves by balancing three elements: operational capacity, legitimacy and support, and clearly articulated public value. Because street sport facilities cannot easily be measured in economic terms, their worth emerges instead as social, cultural and democratic outcomes that must be understood in context.

The interviews revealed that dedicated facilities mattered to street sport communities in three distinct ways. First, the groups had simply lacked any other spaces meeting their practical and cultural needs. The parkour association in Viborg, for example, had spent six years being shuffled between temporary venues, including an unheated hall with uncleaned toilets, before GAME House opened. In Aalborg, the street workout community had relied on weather-dependent outdoor equipment or costly commercial gyms. In Esbjerg, a street roller hockey team described how the facility spared them from dragging goals off the road every time a car passed. Users across all three houses consistently praised the smooth asphalt surface, and many emphasized the cultural atmosphere: the breakdancers in Aalborg explained that the free-spirited street culture of their dance simply did not fit formal studios, while the openable gate panels with large windows let users feel outdoors even inside.

Second, the facilities strengthened local activity-based communities. The skateboarding representative in Esbjerg described how a permanent venue stabilized local interest in a sport whose popularity fluctuates, and how a skate school project with public school classes turned a whole generation into regulars who come because they are skaters, not because it is trendy. In Viborg, the parkour association reported that visibility through the house grew its groups from roughly seven to thirteen participants to around twenty, as children and adults now know that parkour in Viborg happens at GAME House.

Third, and perhaps most strikingly, the facilities publicly recognized street sports and street cultures as legitimate forms of participation. In Esbjerg, a city the skateboarding representative described as dominated by football, handball and ice hockey, the house helped skaters shed a lingering image as troublemakers. The graffiti and street art community experienced an even sharper shift: GAME House gave them a legal wall along a public walkway, where curious passersby stop to ask questions and discover that the people behind the paintings are, in the representative’s words, ordinary people who want to express themselves creatively. The representative noted a preventive effect as well, since artists who once painted illegally in tunnels now have legitimate space to practice their craft.

Yet the study also documents significant tensions. Operational capacity proved uneven: each house runs on just two full-time employees—a daily manager and a project coordinator—supplemented by young junior coordinators and volunteers known as Playmakers. While Viborg and Aalborg recruited substantial volunteer numbers, Esbjerg struggled, which the manager attributed to youth outmigration and limited recruitment capacity. Moreover, the planned model in which affiliated user groups would provide instructors for open training sessions in exchange for facility access often failed in practice. Some groups were too small or loosely organized, others preferred open formats that welcomed everyone regardless of affiliation, and some facilities had been built without a real local user base to sustain organized activities, forcing the houses to hire paid instructors or partner with groups based elsewhere.

The formal governance model fared even worse. The concept envisioned a user council in each house, with representatives from every user association, elected local users and GAME appointees, meeting at least quarterly to ensure democratic influence. In practice, no user council was ever established in any of the three houses. Managers found that many groups focused narrowly on their own discipline and that individual, informal dialogue was more meaningful. In 2018, GAME Esbjerg successfully applied to revise the operational agreement, replacing the closed council model with open workshops accessible to all users. As one facility manager put it, local adaptation is essential: Denmark may be small geographically, but culturally it is big, and no one-size-fits-all concept works.

Legitimacy, by contrast, flowed strongly from both directions. User groups supported the houses because the facilities met their needs, a success the authors link to extensive user involvement during the design phase—though with instructive exceptions. Skateboarders and parkour practitioners in Esbjerg felt their local expertise was overlooked in favor of external consultants, and budget cuts meant many ideas from the workshops never materialized. The parkour setup was criticized for reflecting Copenhagen-style practice rather than local norms, illustrating what researchers call the glocalization of lifestyle sports: street sports may be global, but they are practiced in locally specific ways that facility design must respect. From the municipal side, support was equally strong. Aalborg increased its annual operating subsidy by 250,000 Danish kroner just one year after opening, and extended the extra funding in 2023. Municipalities deliberately positioned GAME House not as a rival to traditional clubs but as an inspiration, holding meetings of the local voluntary sports council at the facility to signal that organized sport stood behind the initiative. External funding from major Danish foundations totaled roughly 1.9 to 2.6 million euros, with municipal co-financing between 0.7 and 1.8 million euros.

The authors conclude that public value in street sport facilities is not a stable, measurable output but a relational, negotiated and context-dependent achievement, emerging from the interaction of spatial design, cultural atmosphere and ongoing organizational adaptation. They also flag a caution for international transferability: GAME’s national reputation, accumulated expertise and organizational infrastructure were central to securing political and financial support, and contexts lacking a comparable central actor may struggle to replicate the model. Finally, the study raises the deeper paradox of institutionalization. Street sport is historically tied to informality and resistance, and practitioners themselves strongly desired stable indoor facilities and recognition—yet converting self-organized practices into publicly governed spaces risks diluting the very autonomy and subcultural distinctiveness that make them meaningful. The GAME Houses suggest that the balance can be struck, but only through continuous negotiation between institutional support and community independence, with flexible managers who listen, adapt and treat local communities as experts in their own practices.

Subject of Research: Public value creation through purpose-built street sport facilities in Danish municipalities

Article Title: Making space for street sport: an exploration of public value creation through the GAME House concept in Danish municipalities

Article References: Larsen, S. H., & Iversen, E. B. (2026). Making space for street sport: an exploration of public value creation through the GAME House concept in Danish municipalities. Frontiers in Sports and Active Living, 8, Article 1867534. https://doi.org/10.3389/fspor.2026.1867534

Image Credits: AI Generated

DOI: 10.3389/fspor.2026.1867534

Keywords: street sports, public value, GAME House, sport facilities, Denmark, sport policy, social inclusion, informal sport, governance, urban culture, skateboarding, parkour

The research team, based at Steno Diabetes Center Copenhagen, interviewed 28 adults aged 17 to 42 who were participating in DiaUnion, a Danish-Swedish screening initiative that targets first-degree relatives of people with type 1 diabetes. Denmark is currently the only country screening first-degree relatives rather than the general population, combining islet autoantibody testing with genetic screening and offering home-based blood sampling alongside digital follow-up. Participants were recruited at different stages of the process: fourteen were still awaiting results, seven had received negative results, and seven had tested positive for one or more autoantibodies. Semi-structured interviews, conducted by telephone, home visit, or clinic meeting between May and August 2025, were analyzed using reflexive thematic analysis.

The biological backdrop matters for understanding what participants were interpreting. Type 1 diabetes is an autoimmune disease in which the immune system progressively destroys the insulin-producing beta cells in the pancreatic islets of Langerhans, leading to absolute insulin deficiency and chronic hyperglycemia. The disease typically progresses silently for years but can be detected in its preclinical stages through blood tests for multiple islet autoantibodies and early signs of dysglycemia. One autoantibody carries roughly a 15 percent risk of developing the disease within ten years; two autoantibodies signal an almost 85 percent risk within fifteen years, and persistent presence of two or more is associated with nearly certain eventual onset. First-degree relatives carry a lifetime risk of about 5 to 10 percent, compared with roughly 0.3 percent in the general population, and adults account for more than half of all new diagnoses—yet most screening research has historically focused on children.

The first major theme the researchers identified concerns how family narratives shape risk perception. Participants whose parents had openly discussed and managed their diabetes during childhood tended to describe the condition as a familiar, integrated part of everyday life rather than a threat. One participant whose mother uses a pump sensor recalled measuring her own blood sugar as a kind of fun childhood activity and described feeling calm about whatever the screening outcome might be. But the researchers noted that this openness was selective: participants described positive experiences while rarely mentioning severe complications, suggesting that some parents practiced a form of protective disclosure, shielding children from the harder realities of the disease. The result is an inherited narrative in which diabetes appears controllable and relatively uncomplicated—a narrative that may contribute to underestimating its seriousness.

The opposite pattern also emerged. Participants who grew up watching a relative struggle with poorly controlled diabetes described childhood fear and a lifelong vigilance about anything that might raise or lower their chances of developing the disease. One participant whose father experienced repeated severe hypoglycemic episodes said the illness had frightened the family and created a desperate desire to avoid anything that might cause it. Concealment added another layer: when diabetes was treated as a family taboo, participants understood it not only as a physical illness but as something associated with shame. Some parents who had difficult experiences actively encouraged their adult children to join the screening program, which the researchers interpret as an attempt to break a family narrative linking diabetes with stigma.

A striking temporal misunderstanding ran through many accounts. Participants frequently anchored their perceived vulnerability to the age at which their parent was diagnosed. One participant noted that her mother developed diabetes at 33 and, with her own 32nd birthday approaching, felt the timing was suddenly relevant to her. Many others concluded that because they had passed the age at which their parent was diagnosed, they were no longer at meaningful risk. The researchers point out that type 1 diabetes can develop at any age and that this life-window framing of genetic susceptibility is biologically inaccurate—yet it serves a protective psychological function, allowing people who feel they have moved beyond the danger period to distance themselves from vulnerability.

The second theme revealed gaps in biomedical knowledge even among people with a close family member with the disease. Several participants believed type 1 diabetes occurs largely at random while type 2 diabetes is the hereditary form, leading them to underestimate their genetic risk. Many described maintaining healthy diets and exercise routines as a way to prevent type 1 diabetes from developing, even though there is currently no evidence that lifestyle behaviors prevent its autoimmune onset. The researchers interpret this emphasis on lifestyle through the lens of the Health Belief Model: focusing on controllable behaviors transforms an unmanageable genetic risk into something that feels predictable, providing emotional comfort and a sense of agency even when perceived control does not align with actual disease mechanisms. One participant acknowledged the possibility herself, wondering aloud whether her calm derived from a kind of false sense of security.

The third theme concerned how screening results themselves were interpreted. Participants repeatedly compared type 1 diabetes favorably to conditions they considered far more severe, particularly cancer, reasoning that people they knew lived normal lives with diabetes and that doctors knew how to handle it. The researchers describe this comparative framing as cognitive reframing—a coping strategy that creates psychological distance from fear by positioning diabetes as survivable and manageable, even though it may downplay the continuous, demanding self-management the disease actually requires. Participants also described diabetes as treatable, a word choice the researchers find telling, since type 1 diabetes is a chronic condition without a cure; what exists are management strategies, not remedies. The perception that medical progress has made the disease nearly curable appears to further reduce fear.

Perhaps most paradoxical was the attitude captured in the study’s title. One participant described the screening as something nice to know rather than need to know, saying the family could live just as good a life without the information. Others forgot they had even taken the test until the result arrived, and those who tested negative reported feeling neither relief nor gratitude—simply, now I know. Participants who tested positive for a single autoantibody often dismissed the result as not serious, positioning themselves outside what they perceived as the real risk group, despite the clinical significance of autoantibody positivity and the need for structured follow-up. Negative results were sometimes treated as definitive reassurance, including reassurance about not having passed genetic risk to children, even though a negative screening result represents only a point-in-time indication rather than a permanent all-clear.

The researchers argue that this downplaying should not be read simply as a failure of knowledge transmission but as active meaning-making. For adult first-degree relatives, familial risk is not new information but a pre-existing condition of life, already managed through normalization, reframing, and perceived controllability. A positive result may feel less like disruptive news and more like confirmation of something long expected, making it psychologically easier to integrate than to reconstruct one’s self-understanding around future disease. Notably, the study’s companion findings on parents of screened children showed a different pattern: those parents engaged with screening as a tool for managing fear and preparing for their child’s possible diagnosis, whereas the adults screened for themselves relied on strategies that normalize and minimize risk.

The practical implications are significant for the growing field of early detection, which has been energized by immunomodulatory therapies such as teplizumab, approved by the European Medicines Agency in January 2026, that can delay clinical onset. The authors conclude that standardized risk communication is insufficient because individuals filter information through established personal and familial narratives. Screening programs, they argue, should adopt more individualized approaches that engage with participants’ existing frameworks of understanding, and should not assume that an absence of expressed need for support means an absence of psychological burden—concerns may simply be managed invisibly through coping strategies that keep them out of sight.

Subject of Research: Risk perception and psychosocial experiences of adult first-degree relatives participating in early detection screening for type 1 diabetes

Article Title: “This is going to be a nice-to-know, not a need-to-know”: absence of concern – a qualitative study of risk perception in early detection of type 1 diabetes

Article References: Pedersen, E. B., Flarup, P. B., Jespersen, L. N., Due-Christensen, M., Antvorskov, J. C., Pociot, F., & Grabowski, D. (2026). “This is going to be a nice-to-know, not a need-to-know”: absence of concern – a qualitative study of risk perception in early detection of type 1 diabetes. Frontiers in Clinical Diabetes and Healthcare, 7, Article 1925120. https://doi.org/10.3389/fcdhc.2026.1925120

Image Credits: AI Generated

DOI: 10.3389/fcdhc.2026.1925120

Keywords: type 1 diabetes, early detection, autoantibody screening, risk perception, first-degree relatives, qualitative research, DiaUnion, psychosocial, health communication, coping strategies, preventive medicine, Denmark

The motivation behind the study is straightforward. Adolescence and early adulthood are periods of heightened vulnerability to mental health problems, and perceived stress is both a symptom and a risk factor for conditions such as depression and anxiety. In Denmark, the PSS-10 has been used in adult populations, but its measurement properties had never been formally assessed in teenagers aged 15 to 20. Without such validation, researchers and clinicians cannot be certain whether the Danish scale actually measures the same construct in young people, whether its scores are stable over time, or whether a given score means the same thing in a 16-year-old as it does in a 40-year-old. The new study set out to answer these questions using a battery of classical psychometric techniques.

The design was ambitious in scale but careful in structure. The team drew a random sample of 5,699 adolescents aged 15 to 20 years and invited them to participate. Of these, 667 completed the PSS-10 in the first round of data collection, forming the test sample. Roughly one week later, 182 of these participants completed the questionnaire a second time, allowing the researchers to assess test-retest reliability, the degree to which scores remain stable when nothing has changed. To examine whether the questionnaire truly relates to clinical reality, a subsample of 38 participants underwent a Schedules for Clinical Assessment in Neuropsychiatry, or SCAN, interview, a gold-standard diagnostic instrument administered by trained psychologists that establishes the presence or absence of psychiatric diagnoses. Data collection was registered and approved by the regional register of research projects on 3 January 2023, and all participants provided informed consent.

The first question the researchers tackled was structural validity: does the ten-item scale measure one underlying construct, or two? This matters because different users score the PSS-10 in different ways. Some researchers compute a single total score, while others, following the original authors, split the items into two subscales, one capturing perceived helplessness and the other perceived self-efficacy, that is, the reverse-worded items asking how often respondents felt in control and on top of things. Using confirmatory factor analysis, a statistical technique that tests how well observed data fit a hypothesized factor structure, the team compared one-factor and two-factor models. The two-factor model showed the best statistical fit, which mirrors findings from many other countries and languages. However, the researchers concluded that the overall pattern of findings supported the use of the total PSS-10 score, a pragmatic conclusion that simplifies interpretation and comparison across studies.

Reliability, the question of how free a measurement is from random error, came out impressively well on both fronts. Internal consistency, which reflects how strongly the ten items hang together, was evaluated using Cronbach’s alpha and reached 0.90, a value conventionally regarded as excellent and one that indicates the items are tapping a coherent construct without being so redundant as to waste respondents’ time. Test-retest reliability over the one-week interval was assessed with the intraclass correlation coefficient, yielding an ICC(2,1) of 0.89, which is high and suggests that, in the absence of real change, an adolescent’s score is remarkably stable across repeat administration. For a self-report scale filled out by teenagers, whose moods and circumstances can shift quickly, this stability is a meaningful endorsement of the instrument.

Perhaps the most practically important number in the paper is the standard error of measurement, which the researchers calculated at 2.65 points. From this they derived the minimal detectable change, the smallest difference between two measurements that can be considered real rather than noise, at 7.34 points. To put that in perspective, the PSS-10 ranges from 0 to 40, so a change of 7.34 corresponds to roughly an 18 percent shift in score. This figure matters enormously for anyone planning to use the scale in intervention studies or clinical monitoring: if a school program or a therapy is evaluated by before-and-after PSS-10 scores, a change smaller than about seven points cannot be confidently interpreted as genuine improvement or deterioration. Providing this measurement-precision benchmark for Danish adolescents gives future studies a principled yardstick rather than a guess.

The study then moved from measurement properties to meaning. Construct validity asks whether scores on the scale correlate with other measures in ways that theory predicts. The PSS-10 scores showed strong correlations with psychiatric symptom scores, supporting the idea that the Danish scale is indeed capturing the psychological distress it is supposed to measure rather than something unrelated. Criterion validity goes one step further and asks whether the scale can stand in for an external standard. Using the subsample of 38 adolescents who completed the SCAN interview, the researchers employed receiver operating characteristic analysis, a technique that plots sensitivity against specificity across all possible cutoff points to summarize discriminative ability in a single number, the area under the curve. The result was an AUC of 0.88, which falls in the good range and indicates that the self-administered questionnaire discriminates between adolescents with and without clinically assessed psychiatric diagnoses considerably better than chance.

That ROC analysis also allowed the team to explore a potential clinical threshold. In the exploratory analyses, a score of 24 or higher emerged as the cutoff that optimally separated adolescents with a psychiatric diagnosis from those without one. If confirmed, such a threshold could eventually help schools, general practitioners, and mental health services identify young people whose self-reported stress warrants a closer clinical look, using a tool that takes only a few minutes to complete. The authors are appropriately cautious on this point, however. The clinical subsample was small, and they explicitly state that larger validation studies are needed before the threshold of 24 can be recommended for practical use. A cutoff derived from 38 participants is a hypothesis to be tested, not a rule to be applied.

The broader significance of the study lies in what it makes possible. Denmark has rich registry data, longitudinal cohort studies, and a strong tradition of adolescent mental health research, but until now the Danish PSS-10 in teenagers rested on an assumption of validity rather than evidence. That assumption can now be replaced with documented estimates of structural validity, internal consistency, test-retest reliability, measurement precision, and construct and criterion validity, all favorable. Researchers designing school-based stress interventions, national surveys, or studies linking perceived stress to later psychiatric outcomes can proceed with confidence in the scale’s total score. The two-factor structure that fit best statistically, combined with the recommendation to use the total score, also reflects a now-common finding in PSS research: the split between positively and negatively worded items often produces a method-driven second factor, but the full scale remains the most robust unit of analysis. For clinicians and researchers elsewhere in Scandinavia and beyond, the study also offers a template, showing how a random population sample, a retest arm, and a clinical interview subsample can together produce a complete psychometric picture. The work was funded by Sygeforsikringen Danmark, which had no role in study design, analysis, or interpretation, and it is published open access. As adolescent stress continues to rise across much of the world, having a validated, translated, and quantitatively characterized tool is a small but consequential step toward measuring, understanding, and ultimately reducing the burden on young minds.

Subject of Research: Psychometric validation of the Danish PSS-10 questionnaire for measuring perceived stress in adolescents

Article Title: Psychometric properties of the Danish PSS-10 in adolescents

Article References: Steen, P. B., Mors, O., Dalgaard, V. L., Sørensen, C. L. B., Andersen, J. H., & Biering, K. (2026). Psychometric properties of the Danish PSS-10 in adolescents. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08601-0

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08601-0

Keywords: PSS-10, perceived stress, adolescents, psychometrics, validation, reliability, Cronbach's alpha, test-retest reliability, confirmatory factor analysis, ROC analysis, BMC Psychiatry, Denmark

The trial, led by Birgith Engelst Grove of AmbuFlex, Centre for Patient-reported Outcomes at Gødstrup Hospital and colleagues at Aarhus University and the Danish Centre for Health Economics, enrolled 152 adults with chronic kidney disease. Participants were randomly allocated in a three-arm design. Forty-seven patients continued with usual outpatient follow-up, serving as the control group. Fifty-four received follow-up built around patient-reported outcomes delivered through telephone consultations, a model the investigators call PRO-tele. The remaining fifty-one were assigned to PRO-based remote monitoring, or PRO-remote, in which patients submitted structured digital questionnaires from home and clinicians responded based on the answers. The trial was registered with ClinicalTrials.gov under identifier NCT03847766, retrospectively registered on 23 January 2019.

The clinical logic of the intervention rests on a concept known as the patient-reported outcome, or PRO. Rather than relying solely on laboratory values such as estimated glomerular filtration rate, the standard measure of kidney filtering capacity, PRO-based care systematically collects patients’ own accounts of symptoms, wellbeing and treatment burden at regular intervals. Algorithms or clinicians then flag responses that suggest deterioration, triggering contact or an earlier appointment. In theory, this creates a safety net that catches problems between scheduled visits while allowing stable patients to skip unnecessary trips to hospital. The PROKID investigators had already established that both digital models were non-inferior to usual care on kidney function; the new study asked the harder question of whether they also made economic sense.

To answer it, the team conducted a full cost-effectiveness analysis over an eighteen-month horizon, following the CHEERS standards for health economic evaluations. Individual-level costs were drawn from Danish national registers, an unusually rich data source that captures nearly every contact patients have with the health system. The cost categories included outpatient and inpatient care, primary care services, medication, and productivity losses. Effects were expressed in two ways: quality-adjusted life-years, or QALYs, which combine survival with health-related quality of life as measured by the EuroQol-5L questionnaire, and the number of patients who met the predefined non-inferiority margin for estimated glomerular filtration rate. Incremental cost-effectiveness ratios were calculated for each intervention against usual care and for the two digital models against each other, with uncertainty quantified through 500 bootstrap replications and summarised in cost-effectiveness acceptability curves.

The headline numbers tell a story of near-equivalence rather than transformation. Mean total costs during the intervention period were €16,664 for the control group, €19,300 for PRO-tele and €18,486 for PRO-remote. Notably, the increases in median costs from the pre-intervention period were similar and statistically non-significant across all three arms: €1,254 for usual care, €1,104 for PRO-tele and €1,009 for PRO-remote. In other words, none of the groups experienced a cost trajectory that meaningfully diverged from the others once baseline spending was taken into account. Chronic kidney disease is expensive to manage regardless of how follow-up is organised, and the digital models did not bend that curve.

On the effectiveness side, PRO-tele produced a small, non-significant QALY gain of 0.08 compared with usual care, with a 95 percent confidence interval running from −0.03 to 0.19, at additional costs of €1,572. That combination yields an incremental cost-effectiveness ratio of €19,552 per QALY gained. PRO-remote showed even smaller differences: €347 in extra costs and a QALY difference of 0.01, with a confidence interval from −0.11 to 0.14, producing an ICER of €31,835 per QALY. Both interventions achieved kidney function progression comparable to the control group, confirming the earlier non-inferiority finding. The confidence intervals, however, straddle zero, which means the data cannot rule out either a modest benefit or a modest harm in quality of life for either digital model.

The cost-effectiveness acceptability curves add a probabilistic layer to these point estimates. At conventional willingness-to-pay thresholds of €30,000 and €50,000 per QALY gained, the probability that either intervention was cost-effective ranged from roughly 40 to 70 percent. Those figures sit in an ambiguous middle zone. They are far from the near-certainty that health systems typically want before scaling a programme nationally, yet they are also not evidence of poor value. The uncertainty stems largely from the modest sample size of 152 patients and the relatively short eighteen-month follow-up, during which few patients with chronic kidney disease die or progress to end-stage renal disease. Longer horizons might reveal differences that this trial could not detect.

The authors’ conclusion is refreshingly candid for a field often accused of overselling digital health. PRO-based follow-up interventions resulted in comparable QALYs and costs relative to usual outpatient follow-up, they report, and the absence of cost savings or significant QALY gains means implementation decisions should also weigh non-economic factors, including patient preferences and workflow integration. That framing matters because cost-effectiveness is only one dimension of the decision. Remote follow-up may still be worth adopting if patients prefer fewer hospital visits, if it frees clinic capacity for other patients, or if it fits smoothly into clinicians’ routines. Conversely, a model that costs the same as usual care but adds digital friction for patients and staff offers little reason to switch.

For the broader debate about telehealth, PROKID offers a sobering data point. The pandemic era produced a wave of enthusiasm for remote care, often based on feasibility studies rather than randomised economic evidence. This trial is one of the few to subject a PRO-based kidney follow-up model to a full economic evaluation alongside a non-inferiority assessment, using register-based costs that avoid the recall bias and incomplete accounting that plague many telehealth analyses. Its message is that clinical equivalence is achievable, but equivalence is not the same as efficiency. Digital follow-up did not reduce total healthcare spending, likely because any savings from fewer outpatient visits were offset by other contacts, intervention infrastructure and the underlying disease burden.

What happens next will depend on how health systems interpret ambiguous economics. A decision-maker applying a €30,000 per QALY threshold would see PRO-tele as a coin flip with a slight edge, while PRO-remote hovers closer to the threshold boundary. The Danish team’s work, funded through the HEALTH CONNECT research programme of Central Denmark Region, provides the evidentiary foundation for that judgement rather than dictating the answer. As chronic disease prevalence climbs and outpatient capacity strains, the pressure to adopt remote monitoring will only grow. PROKID’s contribution is to replace hype with numbers: the technology works clinically, it does not save money in the short term, and the choice to deploy it should rest on patient experience, workflow realities and how much a health system is willing to pay for the possibility of a small quality-of-life gain.

Subject of Research: Cost-effectiveness of patient-reported outcome based digital home monitoring versus usual outpatient follow-up in chronic kidney disease

Article Title: Digital home monitoring versus usual outpatient follow-up in chronic kidney disease: cost-effectiveness of the PROKID randomised non-inferiority trial

Article References: Grove, B. E., Skovsgaard, C. V., Wiben, A., Schougaard, L. M. V., Ivarsen, P., & De Thurah, A. (2026). Digital home monitoring versus usual outpatient follow-up in chronic kidney disease: cost-effectiveness of the PROKID randomised non-inferiority trial. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15795-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15795-2

Keywords: chronic kidney disease, remote patient monitoring, patient-reported outcomes, cost-effectiveness analysis, QALY, telehealth, randomised controlled trial, health economics, eGFR, outpatient follow-up, PROKID trial, Denmark

Semaglutide, marketed under the brand names Wegovy and Ozempic, belongs to a class of medicines known as glucagon-like peptide-1 receptor agonists, or GLP-1RAs. These drugs mimic the action of the gut hormone GLP-1, which stimulates insulin secretion in a glucose-dependent manner, slows gastric emptying and reduces appetite. They have transformed the treatment landscape for type 2 diabetes mellitus and, more recently, for weight management, achieving unprecedented uptake across the globe. Yet almost from the moment incretin-mimetic drugs entered clinical practice, a shadow of concern has followed them. The pancreas sits at the centre of that concern, because GLP-1 signalling acts directly on pancreatic tissue, and the organ’s central role in both digestion and glucose regulation means that any theoretical harm to it would carry serious consequences.

The hypothesis that GLP-1 receptor agonists might raise the risk of pancreatic cancer did not emerge from clinical trials but from a patchwork of early warning signs. Initial safety signals appeared in spontaneous adverse event reporting systems, where physicians occasionally filed reports of pancreatic inflammation and other pancreatic disorders in patients using these drugs. Preclinical studies in rodents added to the anxiety, revealing cellular changes in pancreatic tissue that raised the possibility of a pathway toward malignant transformation. Early case reports also linked GLP-1 medications to acute pancreatitis, a painful and sometimes dangerous inflammatory condition of the gland. Because chronic inflammation is a well-established driver of cancer development in many tissues, researchers and regulators alike questioned whether repeated or persistent pancreatic stimulation by incretin-mimetic drugs could, over years of treatment, eventually elevate the risk of pancreatic cancer — one of the deadliest and most difficult-to-detect malignancies in human medicine.

It was against this backdrop that regulators, as part of the overall original approval process for semaglutide, mandated a post-authorisation safety study to estimate the risk of pancreatic cancer associated with the drug. The design chosen was an active comparator, new user cohort study, a methodological approach widely regarded as the gold standard for assessing drug safety in real-world populations. Rather than comparing semaglutide users with people taking no diabetes medication at all — a comparison that would be hopelessly confounded by differences in disease severity — the investigators compared new users of semaglutide for type 2 diabetes with matched new users of non-incretin antidiabetic drugs, specifically sulfonylureas, SGLT-2 inhibitors or insulin. These comparator drugs are typically used at a similar stage of disease as semaglutide, which helps ensure that the two groups are genuinely comparable in terms of diabetes duration, severity and other characteristics that might independently influence cancer risk.

The scale of the data infrastructure behind the study is one of its defining strengths. Denmark, Sweden and Norway each maintain comprehensive national health registries that capture essentially every prescription filled, every hospital diagnosis and every cancer diagnosis for their entire populations, linked at the individual level through unique personal identifiers. By pooling these registries, the researchers assembled a cohort of 97,464 semaglutide users. Eligible patients had to initiate semaglutide or one of the active comparators and fill at least two prescriptions within the first year of treatment, a requirement designed to ensure that participants were genuinely exposed to their assigned therapy. Follow-up began one year after initiation, an intentional lag period that guards against protopathic bias — the possibility that early symptoms of an undiagnosed pancreatic tumour might prompt a physician to prescribe a new diabetes drug, creating a spurious association between the medication and a cancer that was already developing.

After matching, patient characteristics were well balanced between the semaglutide group and the active comparator cohort. Among the semaglutide users, median age ranged from 59 to 62 years across the three countries, and mean follow-up after the one-year lag period was between 1.40 and 1.85 years. During the observation window, 131 incident pancreatic cancer events occurred among semaglutide users and 123 among active comparator users, accumulated over 167,399 and 140,306 person-years of follow-up respectively. The incidence rates were strikingly similar between the two groups in every country, ranging from 0.64 to 0.91 per 1,000 people per year among semaglutide users and from 0.80 to 0.98 per 1,000 people per year among active comparator users. In other words, the raw cancer rates in the two treatment groups overlapped almost completely before any statistical modelling was even applied.

The formal statistical analysis confirmed what the raw numbers suggested. The primary outcome, incident pancreatic cancer, was analysed using country-specific hazard ratios and incidence rate differences, which were then pooled across the three countries using a fixed-effects meta-analysis. In Denmark, the hazard ratio for pancreatic cancer with semaglutide versus active comparators was 1.00, with a 95 percent confidence interval of 0.66 to 1.51 — a value of exactly one indicating no difference in risk whatsoever. In Sweden, the hazard ratio was 0.82 (95 percent confidence interval 0.56 to 1.22), and in Norway it was 0.91 (95 percent confidence interval 0.55 to 1.51). The pooled estimate across all three countries showed no increased risk, with a hazard ratio of 0.91 (95 percent confidence interval 0.71 to 1.16) and an incidence rate difference — the absolute change in risk — of minus 0.10 per 1,000 person-years, with a confidence interval spanning from minus 0.31 to plus 0.10. Every confidence interval comfortably included the null value of no effect.

Just as important as the headline result was the pattern of secondary and sensitivity findings. If a drug truly caused cancer, one would generally expect to see a dose-response relationship, with risk climbing as cumulative exposure increases, and a duration effect, with risk rising the longer patients remain on therapy. Neither pattern appeared. The pooled hazard ratio for high-dose semaglutide use was 0.74 (95 percent confidence interval 0.40 to 1.40), and the pooled hazard ratio for long duration of use was 0.79 (95 percent confidence interval 0.37 to 1.69) — both point estimates below one and both statistically compatible with no effect. The researchers also performed extensive sensitivity and supplementary analyses to probe the robustness of their conclusions, and these consistently showed no increased risk, regardless of how the analyses were configured. This internal consistency across countries, doses, durations and analytical approaches substantially strengthens the credibility of the null finding.

Professor Pottegård summarised the implications of the work in his presentation, stating that the comprehensive study, using nationwide registry data from three countries, found no increased risk of pancreatic cancer with the use of semaglutide compared with other glucose-lowering drugs used at a similar stage in the treatment of type 2 diabetes. He emphasised that the conclusion was supported by the absence of any cumulative dose-response or dose-duration effect, by consistent findings in the individual countries, and by a wide range of supplementary and sensitivity analyses. He further noted that the results align with the current external evidence base, thereby strengthening the overall argument that semaglutide does not increase the risk of pancreatic cancer. For the millions of patients now taking the drug worldwide, and for the clinicians who prescribe it, this convergence of registry-scale real-world data with prior evidence offers a measure of clarity that early case reports and rodent studies could never provide.

Some caveats are worth bearing in mind. The research was presented as an oral presentation, abstract LBA 35, at the EASD meeting in Milan, and no full article is available at this stage; the work has not yet been submitted to a medical journal for peer-reviewed publication, so the findings should be regarded as preliminary until they appear in the scientific literature. The mean follow-up of roughly one and a half to two years, while appropriate for the question of newly emerging cancers, cannot rule out effects that might manifest only after many more years of exposure, and continued pharmacovigilance will remain essential as the treated population ages. The study was funded by Novo, the manufacturer of semaglutide, a fact that regulators explicitly anticipated by mandating the study design and comparator choices as a condition of approval. Nevertheless, the sheer scale of the Nordic registry infrastructure, the active-comparator design, the balanced cohorts and the consistency of every analysis performed make this one of the most definitive real-world assessments to date of a safety concern that has shadowed GLP-1 receptor agonists since their introduction — and that concern, at least for pancreatic cancer, now appears substantially diminished.

Subject of Research: Post-authorisation safety study of semaglutide and pancreatic cancer risk in type 2 diabetes patients

Article Title: Regulator-mandated study finds no link between semaglutide use and pancreatic cancer using nationwide registry data from Denmark, Sweden and Norway

Article References: Regulator-mandated study finds no link between semaglutide use and pancreatic cancer using nationwide registry data from Denmark, Sweden and Norway. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: semaglutide, pancreatic cancer, GLP-1 receptor agonists, type 2 diabetes, drug safety, registry study, Denmark, Sweden, Norway, EASD, pharmacovigilance, Novo

The team’s starting point was a long-standing tension in field teaching. Fieldwork sits at the heart of Earth science, and decades of research confirm that taking students into the field connects materials and processes, makes theoretical knowledge relevant, and deepens understanding of key scientific principles. But as the researchers point out, the open exploration that drives scientific fieldwork is rarely reproduced in teaching. Most field trips follow a linear, pre-designed structure that moves students through selected locations or outcrops, a format that, according to earlier work by Frederick Granshaw and Don Duggan-Haas, lacks the fundamental exploratory nature of real research. The same constraint applies with even greater force in virtual environments, where the developer decides in advance what content students will encounter. The challenge the team set themselves was to design a virtual field experience in which the student’s actual task is to explore, gather data, and generate hypotheses rather than simply absorb a narrated story.

Their answer draws on a pedagogical tradition that stretches back more than a century. Inquiry-based learning, formalised in science education during the 1980s as the 5E model, sequences lessons through the phases of Engage, Explore, Explain, Expand, and Evaluate, placing students’ own explorations at the centre of instruction. The intellectual roots go back to John Dewey’s 1933 description of the five phases of reflective thinking, which later inspired problem-based learning and learning cycle models. The researchers added a further phase, Elicit, introduced by Arthur Eisenkraft in 2003, which engages students and maps their prior knowledge before exploration begins. In their design, the lesson opens with open-ended questions that surface what students already believe, then hands them the virtual environment and lets them investigate freely. The authors note that while research on inquiry does not yield definitive results because of the complex character of learning science, there is now broad acceptance within science education that inquiry fosters both learning and engagement.

The virtual fieldwork module itself is aimed at Danish upper secondary students aged 16 to 19 enrolled in an elective Physical Geography course, and it can run as a single 90-minute session or as two, depending on students’ prior experience with inquiry and virtual environments. The learning goals are ambitious: students should be able to observe and distinguish three field localities, classify their rocks and fossils, determine their relative ages, and use that information to infer past environments and geological time. The three localities are Møns Klint, Stevns Klint, and Faxe Kalkbrud, Danish sites that together represent connected but distinct geological periods around the end of the Cretaceous, spanning the Cretaceous-Paleogene boundary, when a severe mass extinction transformed life on Earth 66 million years ago. The lesson culminates with students using their knowledge of past mass extinctions, geological deposits, and environmental change to predict what geological deposits from our own era might look like in the far future, linking deep-time climate change to the present crisis.

Technically, the environment is built from 360-degree video recordings modified with the software platform Thinglink, an approach that keeps production costs low while preserving the sense of standing in a real landscape. One of the team’s most interesting design choices involves scale. Into the 360-degree videos they embedded both microfossils and macrofossils, allowing students to explore across multiple scales simultaneously. This proved challenging for the students, but the researchers argue both scales are essential: the fossils establish a link between two distinguishable environments, and that link is one of the indicators of environmental change that students must work out to solve the geological puzzle. The ability to move safely and easily across large virtual distances and across scales is, as the authors note in their discussion, one of the genuine advantages virtual environments hold over physical fieldwork, and here it is put to work in service of genuine scientific reasoning rather than mere sightseeing.

The lesson’s structure follows an eight-part inquiry cycle that the researchers present as a diagram: Elicit, Engage, Explore, Explain I, Explain II, Extend I, Extend II, and a continuous Feedback loop running through the middle of the activity. The cyclic design deliberately emulates the practice of science, using the outcomes of one exploration to engage students in the next inquiry cycle. The authors emphasise that this communicates an important message about how science works: finding an answer is not the end of a scientific investigation but a possible motivation to continue exploring. Feedback sits at the centre of the design because both students and the teacher give and receive it throughout the activity, supporting formative assessment at every stage rather than confining evaluation to a final test.

Two phases of the cycle carry particular weight in the team’s analysis. The Explain stages are critical for scaffolding knowledge, helping students approach questions such as how the fossil record translates into time and geological history, and how different physical sites can be compared and contrasted. During both real fieldwork and this exercise, the researchers expect this scaffolding to emerge as students ask questions of one another and of their teachers. Peer learning, they note, is an important component of fieldwork in nature, and in the virtual version it is essential for communicating and connecting specific knowledge from the three localities into the shared geological story assembled in the classroom. The Extend activities then push students toward the higher levels of Bloom’s revised taxonomy, where knowledge can be interpreted and applied rather than merely recalled, with teacher prompts playing the same guiding role they do in the field.

The researchers are candid about the broader lesson their design effort carries for the field. As they recount, Glenn Dolphin and colleagues found in 2019 that when geoscientists, computer scientists, and psychologists embraced virtual reality to mitigate the problem of large student populations, they instead uncovered a fundamental pedagogical problem: how geology itself is taught. Dolphin’s team proposed teaching geology with more emphasis on how geology works, so that students better understand the relationship between inference and observation in fieldwork. That emphasis is precisely what inquiry-based learning is built to deliver, and it is what the new module attempts in digital form. The authors also suggest that the virtual tasks can be extended into a laboratory or workshop classroom setting, and that the engaging fossil-hunting experience can motivate students to consider authentic contemporary problems, including the sixth mass extinction event that scientists warn is now underway.

The team’s conclusion is cautiously optimistic. Building an inquiry lesson with a virtual reality component, they write, challenged the format without letting it collapse into a show-and-tell exercise. The motivation generated by the rich digital 360-degree environment, combined with the goal of mapping a genuine geological problem, carries students beyond simply wanting a correct answer. Instead, the design acknowledges and uses students’ own answers, on which the teacher then builds toward what scientists actually think, offering students the reward of figuring out a reasonable explanation for a scientific problem and having their thinking recognised. For a field still grappling with how to integrate virtual fieldwork with inquiry at the secondary level, the module offers a concrete, freely available template. The complete lesson materials have been deposited on Zenodo, allowing other teachers to test whether a carefully designed virtual world can do what the best field trips have always promised: turn students from spectators into investigators.

Subject of Research: Inquiry-based virtual fieldwork design for upper secondary geoscience education using 360-degree videos

Article Title: GC Insights: Designing for inquiry in virtual fieldwork

Article References: Malm, R. H., Hansen, K. R. S., Evans, R., Madsen, L. M., Milán, J., Thibaut, N., & Kennedy, B. (2026). GC Insights: Designing for inquiry in virtual fieldwork. Geoscience Communication, 9(2), 139-144. https://doi.org/10.5194/gc-9-139-2026

Image Credits: AI Generated

DOI: 10.5194/gc-9-139-2026

Keywords: virtual fieldwork, inquiry-based learning, geoscience education, 360-degree video, 5E model, Cretaceous-Paleogene boundary, mass extinction, upper secondary education, Thinglink, Denmark, climate change education, Geoscience Communication

The study, published in The Scandinavian Journal of Economics under the title Sin taxes in a sealed market: dilution and leakage related to cross-border shopping, was conducted by Magnus Munk Bjerg, Carl-Emil Pless, Christopher Posselt and Sinne Smed, all of the Department of Food and Resource Economics at the University of Copenhagen. Rather than estimating what Danes buy in German border shops, the researchers took a different approach: they examined what happened to Danish households’ purchasing patterns when cross-border shopping became effectively impossible during the COVID-19 border closures of 2020 and 2021. The logic is straightforward. If the authorities are correct that purchases made in Germany would simply migrate back to Danish shops in the absence of the border option, then the closure periods should reveal a large surge in domestic spending on the affected goods. What the researchers found instead was a considerably smaller shift.

The numbers at the centre of the dispute are striking. According to the Danish Ministry of Taxation, the Danish state lost DKK 1.16 billion in 2019 due to cross-border shopping, excluding tobacco products, and the ministry’s broader annual estimate for sin goods stands at approximately DKK 1.5 billion. The ministry arrives at these figures by basing its calculations on what Danes are observed buying in Germany. The University of Copenhagen team’s estimate, by contrast, comes in at DKK 415 million, roughly a third of the official figure. The gap, the researchers argue, stems from a fundamental assumption embedded in the ministry’s method: that all purchases made in Germany would instead have been made in Denmark if the border had been closed. Their findings show that this is not the case. Danes purchase only a fraction of the products in Denmark that they previously bought in Germany, which means the actual financial loss to the state is substantially smaller than the official accounting implies.

Magnus Munk Bjerg, a PhD student at the Department of Food and Resource Economics and co-author of the study, explains the distinction between the two approaches. The Ministry of Taxation bases its calculations on what Danes buy in Germany, but if the goal is to understand what Denmark actually loses, the relevant question is what happens to consumption inside Denmark. That, he says, is precisely what the research team set out to measure. He also offers a behavioural explanation for why Danes do not simply substitute the same basket of products in domestic shops once the border option disappears. Once people have packed the car or trailer and driven a considerable distance, they are likely to buy a range of additional products to make the trip worthwhile. In other words, a substantial share of what is recorded as cross-border spending is not a one-for-one substitute for domestic purchases at all, but rather additional consumption that would not otherwise occur.

The empirical design of the study exploits a natural experiment created by the pandemic. During the COVID-19 lockdowns, the closure of the Danish-German border removed the cross-border shopping option for everyone, allowing the researchers to observe how domestic demand responded when the cheaper German alternative vanished. To isolate the effect, they divided Denmark into geographic groups based on distance from the nearest border shop. Households in postcodes within 150 kilometres of the nearest border shop lost access to cross-border shopping during the lockdowns and could therefore be expected to shift their spending. These households were compared with households in postcodes across the rest of Jutland and Funen, which were affected by the same lockdowns but lived too far from the border for a cross-border trip to be financially worthwhile. Zealand, Lolland-Falster and Bornholm were excluded from the analysis because residents of those regions can access cross-border shopping via bridges and ferries, complicating the distance-based comparison. Postcode districts with no households participating in the research panel were also set aside.

The results reveal that cross-border shopping is, above all, a local phenomenon. Households living within 30 kilometres of the border increased their spending on sin goods in Danish shops by 109 percent when the border closed, a dramatic shift indicating that for these communities, shopping in Germany had been a routine and significant part of household consumption. The affected category of sin goods was broad, encompassing sweets, chocolate, crisps, soft drinks, beer, wine and spirits. Averaged across all households living within 150 kilometres of the border, spending on sin goods in Danish shops rose by 21 percent as a result of the border closure. Perhaps most telling for national policy: beyond 120 kilometres from the border, the researchers could detect no change in household consumption patterns at all. Distance, in other words, is decisive. For most of the country, the option of shopping in Germany is simply too costly and inconvenient to influence behaviour, and taxes on unhealthy products operate on those households exactly as intended.

The researchers are careful to stress that cross-border shopping remains highly significant for people living close to the border, and their findings do not erase that reality. Nevertheless, the study carries an important message for the national debate. Carl-Emil Pless, a postdoctoral researcher and co-author, notes that if the policy objective of taxing these products is both to increase government revenue and improve public health, the findings suggest that those effects are likely to be fully realised for the vast majority of Danish households. If sin taxes on these goods were increased tomorrow, the results indicate that it would primarily be people living close to the border who would respond by shopping across it. Some residents of the border region might travel to Germany even more frequently than they already do, Pless observes, but this is a relatively small group overall, and the effect is therefore primarily local rather than national.

Methodologically, the study draws on data from the YouGov Shopper Panel, a panel of Danish households that continuously records grocery purchases, giving the researchers a detailed longitudinal picture of what households bought before, during and after the border closures. To guard against artefacts of a single data source, the findings were validated using an independent dataset from Spenderlog. This dual-source validation matters for a study whose conclusions contradict official government estimates, because the credibility of the result rests on the quality of the underlying consumption data. By observing actual household behaviour in a period when the cross-border option was removed, the researchers were able to measure the substitution between German and Danish purchases directly, rather than inferring it from records of what Danes bought abroad. That direct measurement is what allows them to conclude that the leakage of tax revenue is far more limited than the ministry’s method suggests.

Beyond the specific numbers, the study has implications for how policymakers think about the optimal level of taxation on sin goods. The researchers are explicit that they are not prescribing what the tax rate should be. But their results show, in Bjerg’s words, that cross-border shopping should carry less weight when policymakers decide how taxes on unhealthy foods ought to be designed. For a country that has long weighed public health goals against the fear of revenue draining south across the border, the message is that the fear has been overstated. The revenue and health benefits of taxing sweets, soft drinks and alcohol appear to reach nearly the whole population, with the dilution effect confined to a narrow band of border communities. As debates over sugar taxes and health-motivated levies continue across Europe, the Danish case offers a quantified reminder that the geography of consumer behaviour, not just the level of the tax, determines how much a national tax policy actually loses to its neighbours.

Subject of Research: The effect of cross-border shopping on the revenue effectiveness of Danish sin taxes

Article Title: Cross-border shopping dilutes public revenue less than previously thought

Article References: Cross-border shopping dilutes public revenue less than previously thought. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: sin taxes, cross-border shopping, Denmark, Germany, VAT, public revenue, Danish Ministry of Taxation, University of Copenhagen, COVID-19 border closures, consumer behaviour, unhealthy foods, tax policy

What sets this study apart from much of the existing literature on occupational health in nursing is its starting point. Most previous investigations have examined nurses and midwives later in their working lives, when patterns of ill health, sector switching and early retirement are already well established. That approach carries a serious methodological risk: employees who have been harmed by their working conditions may already have moved into other sectors or left the labour market altogether by the time researchers look at the data, leaving behind a selectively healthier workforce. By following newly qualified graduates from their very first job and for six years thereafter, the Danish team was able to capture health trajectories at the earliest possible stage, before such selective attrition could distort the picture.

The study drew on nationwide Danish registers, a resource that allows researchers to track entire populations across employment, healthcare and social administrative systems with minimal loss to follow-up. The researchers identified people who completed a bachelor’s degree and entered employment no later than 180 days after graduation between 2010 and 2015. Using a target trial emulation framework, a design borrowed from epidemiology that mimics the logic of a randomised trial using observational data, they compared hospital-based nurses and midwives with newly qualified graduates of the same educational level who began working in 36 other sectors. The final analysis included 8,752 people, each followed for six years from their first job.

To make the comparison as fair as possible, the groups were matched on a wide range of background characteristics. These included age, gender, ethnicity, marital status, number of children, municipality of residence, the timing of their first job and their use of healthcare services before entering employment. Matching on pre-employment healthcare use is particularly important, because it reduces the chance that the hospital group simply started out with worse health than the comparison group. Even so, the researchers acknowledge that they cannot rule out all differences between people who choose different professions and workplaces, a limitation inherent to any observational design that compares self-selected occupational groups.

The headline results are quantitative and unambiguous. During the first four years of employment, hospital-based nurses and midwives had a higher annual likelihood of both long-term sick leave and diagnosed back disorders than their counterparts in other sectors. The difference reached up to 2.8 percentage points per year for long-term sickness absence and up to 0.6 percentage points for diagnosed back disorders. While these figures may appear modest at the level of an individual year, they accumulate across a workforce and across a career. After around four years, the gaps between the groups narrowed, but, as the researchers emphasise, this convergence does not necessarily mean that the health of those remaining in hospitals was improving.

The reason for that caution lies in one of the study’s most revealing supplementary analyses. Around 13 per cent of the hospital-based nurses and midwives left hospital work altogether during the six-year follow-up period. When the researchers examined the health trajectories of these leavers, they found that long-term sickness absence and recorded mental health problems increased in the period leading up to their departure from hospital work and declined again afterwards. In other words, part of the apparent narrowing of the health gap after a few years may reflect a healthy worker effect in reverse: employees whose health is deteriorating gradually exit hospital employment, so the remaining workforce appears healthier on average even if no individual has recovered. Paaske noted that when the differences become smaller after a few years, one cannot simply conclude that the health of those working in hospitals is improving, because employees with health problems may be gradually leaving hospital work. This also implies that studies restricted to people who remain in hospital work may present an overly positive picture of how health develops in the profession.

The researchers are careful to point out that their analysis describes developments before and after leaving hospital work but cannot establish that leaving in itself causes better health. The design is observational, and the observed improvements after departure could reflect recovery, changed working conditions, or other factors that the registers cannot capture. What the analysis does establish is a temporal pattern, rising ill health before exit and improvement after, that is consistent with the hypothesis that working conditions in hospitals contribute to the health problems of early career nurses and midwives, while stopping short of proving it.

One result initially appears to point in the opposite direction. Hospital-based nurses and midwives were less likely than the comparison group to have recorded use of healthcare services and treatment related to mental health conditions, including talking therapy with a general practitioner, medication, psychological treatment and psychiatric treatment. The researchers urge strong caution in interpreting this finding. Because the study is based on register data, the researchers do not measure participants’ mental well-being directly; they can only observe whether a person has a recorded diagnosis or has received certain types of treatment. Psychological strain that has not resulted in contact with the healthcare system, or that has not yet produced a diagnosis, remains invisible in the data. Paaske stressed that the lower use of treatment and healthcare services should not be interpreted as evidence that hospital-based nurses and midwives have better mental health, and that the higher level of sickness absence may, among other things, reflect psychological strain that has not yet resulted in a recorded diagnosis or treatment. The finding therefore speaks to recorded healthcare use rather than to actual mental well-being.

The technical limitations of register-based research frame the scope of the conclusions. Registers can only provide information about health conditions that are actually recorded, which means undiagnosed disorders, untreated strain and health behaviours are outside the analytical window. Moreover, the results concern the first six years of employment for the specific groups included in the study and cannot automatically be generalised to all nurses and midwives working in hospitals, whether in Denmark or elsewhere. The study was funded by Helsefonden and Lån & Spar Fonden, and its method of research was data and statistical analysis of national registers, with people as the subject of research.

Despite these caveats, the study carries a clear message for health system policy at a time when many countries struggle to retain nursing and midwifery staff. Because the newly qualified employees are at the beginning of their working lives, even a modest increase in long-term sickness absence and early departure from hospital work could have consequences over an entire career, both for the individuals concerned and for workforce planning in hospitals. The researchers suggest that the first years after graduation are an important period to focus on if hospitals are to retain more nurses and midwives, although the results do not in themselves identify which specific conditions in hospitals need to change. By following employees from the very start of their working lives and continuing to follow them after they leave hospital work, the study offers a perspective on the relationship between work and health that studies of later-career employees cannot provide, and it signals that the earliest years of a nursing or midwifery career may be decisive for both health and retention.

Subject of Research: Long-term sickness absence and health trajectories of early career hospital nurses and midwives in Denmark

Article Title: Newly qualified nurses and midwives have higher rates of long-term sickness absence

Article References: Newly qualified nurses and midwives have higher rates of long-term sickness absence. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: nurses, midwives, long-term sickness absence, back disorders, occupational health, register data, Denmark, early career, workforce retention, mental health, hospital work, health economics