• COVID-19
• Publicationsclose
• Other research productsclose
• 2018-2022close
• Open Access close
• DK close
• English close
• Copenhagen University Research Information System close
• Knowmad Institut close

This article's main contributions are twofold: 1) to demonstrate how to apply the general European Union's High-Level Expert Group's (EU HLEG) guidelines for trustworthy AI in practice for the domain of healthcare and 2) to investigate the research question of what does "trustworthy AI" mean at the time of the COVID-19 pandemic. To this end, we present the results of a post-hoc self-assessment to evaluate the trustworthiness of an AI system for predicting a multiregional score conveying the degree of lung compromise in COVID-19 patients, developed and verified by an interdisciplinary team with members from academia, public hospitals, and industry in time of pandemic. The AI system aims to help radiologists to estimate and communicate the severity of damage in a patient's lung from Chest X-rays. It has been experimentally deployed in the radiology department of the ASST Spedali Civili clinic in Brescia, Italy, since December 2020 during pandemic time. The methodology we have applied for our post-hoc assessment, called Z-Inspection®, uses sociotechnical scenarios to identify ethical, technical, and domain-specific issues in the use of the AI system in the context of the pandemic.

ObjectivesThere are indications that the COVID-19 pandemic has had a profound negative effect on psychological well-being. Here, we investigated this hypothesis using longitudinal data from a large global cohort of runners, providing unprecedented leverage for understanding how the temporal development in the pandemic pressure relates to well-being across countries.DesignProspective cohort study.SettingGlobal.ParticipantsWe used data from the worldwide Garmin-RUNSAFE cohort that recruited runners with a Garmin Connect account, which is used for storing running activities tracked by a Garmin device. A total of 7808 Garmin Connect users from 86 countries participated.Primary and secondary outcome measuresFrom 1 August 2019 (prepandemic) to 31 December 2020, participants completed surveys every second week that included the five-item WHO Well-Being Index (WHO-5). Pandemic pressure was proxied by the number of COVID-19-related deaths per country, retrieved from the Coronavirus Resource Centre at Johns Hopkins University. Panel data regression including individual- and time-fixed effects was used to study the association between country-level COVID-19-related deaths over the past 14 days and individual-level self-reported well-being over the past 14 days.ResultsThe 7808 participants completed a total of 125 409 WHO-5 records over the study period. We found a statistically significant inverse relationship between the number of COVID-19-related deaths and the level of psychological well-being—independent of running activity and running injuries (a reduction of 1.42 WHO-5 points per COVID-19-related death per 10 000 individuals, p<0.001).ConclusionsThis study suggests that the COVID-19 pandemic has had a negative effect on the psychological well-being of the affected populations, which is concerning from a global mental health perspective.

Abstract Background : The COVID-19 pandemic significantly disrupted health services and their staff, including nursing and midwifery educators. Nursing and midwifery educators were tasked with meeting nurses’ and midwives’ rapidly-changing educational requirements, and supporting the nursing and midwifery workforce through the pandemic. Thus, nursing and midwifery educators were pivotal to the pandemic response. Aim : To assess the impact of the COVID-19 pandemic on nursing and midwifery educators across four large, multi-site Australian health services. Methods : Qualitative descriptive study. All nursing and midwifery educators from public health services in Melbourne, Victoria (n=3) and Adelaide, South Australia (n=1) were invited to participate in a semi-structured interview (July – November 2020). Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically. Findings : Forty-six nursing and midwifery educators participated in interviews. Across the health services, two similar themes and six sub-themes were identified. In the first theme, ‘Occupational impacts of COVID-19’, participants described adjusting to providing education during the pandemic, managing increased workloads, concerns about not being able to carry out their usual education activities and the importance of support at work. The second theme, ‘Psychological impacts of COVID-19’, included two sub-themes: the negative impact on participants’ own mental health and difficulties supporting the mental health of other staff members. Participants from all health services identified unexpected positive impacts; online education, virtual meetings and working at home were perceived as practices to be continued post-pandemic. Conclusions : Hospital-based nursing and midwifery educators demonstrated agility in adjusting to the fast-changing requirements of providing education during the pandemic. Educators would benefit from continued occupational and psychosocial support during the COVID-19 pandemic, and inclusion in discussions to inform hospitals’ preparedness for managing the education of nurses and midwives during future pandemics.

BACKGROUND: The evidence on mental health during COVID-19 evolved fast, but still little is known about the long-lasting impact of the sequential lockdowns. We examine changes in young people's mental health from before to during the initial and second more prolonged lockdown, and whether women and those with pre-existing depressive symptoms were disproportionally impacted.METHODS: Participants reported on mental health indicators in an ongoing 18-year data collection in the Danish National Birth Cohort and in a COVID-19 survey, including 8 data points: 7 in the initial lockdown, and 1 year post. Changes in quality of life (QoL), mental well-being, and loneliness were estimated with random effect linear regressions on longitudinal data (N = 32,985), and linear regressions on repeated cross-sections (N = 28,579).FINDINGS: Interim deterioration in mental well-being and loneliness was observed during the initial lockdown, and only in those without pre-existing depressive symptoms. During the second lockdown, a modest deterioration was again observed for mental well-being and loneliness. QoL likewise only declined among those without pre-existing symptoms, where women showed a greater decline than men. QoL did not normalise during the initial lockdown and remained at lower levels during the second lockdown. These findings were not replicated in the repeated cross-sections.INTERPRETATION: Except for an interim decrease in mental health, and only in those without pre-existing depressive symptoms, this study's findings do not suggest a substantial detrimental impact of the lockdowns.

Background Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. Methods This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0–16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis. Findings The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03–1·36]) and poorer sleep quality (1·13 [1·03–1·24]) but not symptoms of anxiety (0·97 [0·91–1·03]) or COVID-19-related distress (1·05 [0·93–1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75–0·91]) and anxiety (0·77 [0·63–0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27–2·05]) and anxiety (1·43 [1·26–1·63]) than those not diagnosed throughout the study period. Interpretation Severe acute COVID-19 illness—indicated by extended time bedridden—is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19.Funding Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council.

AbstractMany studies have investigated the impact of the COVID-19 pandemic on mental health. Throughout the pandemic, time spent at home increased to a great extent due to restrictive measures. Here we set out to investigate the relationship between housing conditions and the mental health of populations across European countries. We analyzed survey data collected during spring 2020 from 69,136 individuals from four cohorts from Denmark, France, and the UK. The investigated housing conditions included household density, composition, and crowding, access to outdoor facilities, dwelling type, and urbanicity. The outcomes were loneliness, anxiety, and life satisfaction. Logistic regression models were used, and results were pooled using random-effects meta-analysis. In the meta-analysis, living alone was associated with higher levels of loneliness (OR = 3.08, 95% CI 1.87–5.07), and lower life satisfaction (OR = 1.27, 95% CI 1.05–0.55), compared to living with others. Not having access to an outdoor space and household crowding were suggestively associated with worse outcomes. Living in crowded households, living alone, or lacking access to outdoor facilities may be particularly important in contributing to poor mental health during a lockdown. Addressing the observed fundamental issues related to housing conditions within society will likely have positive effects in reducing social inequalities, as well as improving preparedness for future pandemics.

A COVID-19 diagnosis is primarily determined by RT-PCR or rapid lateral-flow testing, although chest imaging has been shown to detect manifestations of the virus. This article reviews the role of imaging (CT and X-ray), in the diagnosis of COVID-19, focusing on the published studies that have applied artificial intelligence with the purpose of detecting COVID-19 or reaching a differential diagnosis between various respiratory infections. In this study, ArXiv, MedRxiv, PubMed, and Google Scholar were searched for studies using the criteria terms ‘deep learning’, ‘artificial intelligence’, ‘medical imaging’, ‘COVID-19’ and ‘SARS-CoV-2’. The identified studies were assessed using a modified version of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD). Twenty studies fulfilled the inclusion criteria for this review. Out of those selected, 11 papers evaluated the use of artificial intelligence (AI) for chest X-ray and 12 for CT. The size of datasets ranged from 239 to 19,250 images, with sensitivities, specificities and AUCs ranging from 0.789–1.00, 0.843–1.00 and 0.850–1.00. While AI demonstrates excellent diagnostic potential, broader application of this method is hindered by the lack of relevant comparators in studies, sufficiently sized datasets, and independent testing.

AbstractBackgroundYouth’s mental health has on average declined initially during the pandemic and few studies have investigated whether these declines were dependent on housing conditions.MethodsWe used data from 7445 youth from the Danish National Birth Cohort (DNBC), collected at participants’ 18th year of life and subsequently three weeks into the initial national lockdown (April 2020). We examined associations between housing conditions (access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health parameters (mental well-being, Quality of Life (QoL) and loneliness. We report results from multivariate linear and logistic regression models.FindingsYouth without access to outdoor spaces had a greater decrease in mental well-being compared to those with a garden, mean difference: -0·83 (95 % CI -1·19,-0·48), and correspondingly greater odds of onset of low mental well-being, OR: 1·68 (95 % CI 1·15, 2·47). Youth in higher density households and those living alone also had greater odds of onset of low mental well-being (OR: 1·23 (95 % CI 1·05, 1·43) and OR: 1·47 (95 % CI 1·05, 2·07), respectively). Onset of low QoL was associated with living in denser households, as well as living alone. Living alone more than doubled odds of onset of loneliness, OR: 2·12 (95 % CI 1·59, 2·82).InterpretationNot all youth were equally affected by the pandemic and our findings inform policy makers that youth living alone, in denser households, and without direct access to outdoor spaces are especially vulnerable to mental health declines.Research in contextEvidence before this studyMental health is associated with certain housing characteristics, such as access to green space and household composition. Additionally, we know that mental health amongst youth has been especially impacted by the COVID-19 pandemic and/or social restrictions, at a time where a majority of youth spend more time at home. Cross-sectional studies have indicated that housing conditions during the initial lockdowns were associated with mental health among youth.Added value to this studyWe are able to provide evidence that housing conditions have been important factors in how youth’s mental health has changed, due to data collections in our cohort before and during the pandemic. We demonstrate that living alone without access to outdoor spaces and in denser households during lockdown are all associated with deteriorations in mental health in a longitudinal design. The deteriorations in mental well-being are at a level indicative of anxiety and/or depression, indicating that these mental health changes are meaningful from a public health perspective. To our knowledge, this is the first study to examine associations longitudinally in a youth cohort.Implications of all the available evidenceNot all youth will be equally affected by the pandemic and social restrictions. Public health recommendations could be that youth avoid living alone, in dense households and without access to outdoor spaces during a lockdown, if this is at all possible to choose. Additionally, mental health and public health professionals should be aware of these vulnerabilities as they seek to assist youth at times when social restrictions are in place to control community transmission. Additionally, as we look to the future and work towards equitable and health-promoting housing, we must consider aspects that are important to mental health during pandemics and otherwise.

This article investigates school belonging among migrant students and how this changed during the Covid‐19 pandemic. Drawing on quantitative data gathered from 751 migrant students in secondary schools in six European countries (Belgium, Denmark, Finland, Norway, Sweden, and the UK), we examined the impact of Covid‐19 school closures, social support, and post‐traumatic stress symptoms on changes in school belonging. Linear regression showed a non‐significant decrease in school belonging, and none of the studied variables had a significant effect on this change in our whole sample. However, sensitivity analysis on a subsample from three countries (Denmark, Finland, and the UK) showed a small but significant negative effect of increasing post‐traumatic stress symptoms on school belonging during Covid‐19 school closures. Given that scholarship on school belonging during Covid‐19 is emergent, this study delineates some key areas for future research on the relationship between wellbeing, school belonging, and inclusion. publishedVersion Peer reviewed

Abstract Background The COVID-19 pandemic and its associated national lockdowns have been linked to deteriorations in mental health worldwide. A number of studies analysed changes in mental health indicators during the pandemic; however, these studies generally had a small number of timepoints, and focused on the initial months of the pandemic. Furthermore, most studies followed-up the same individuals, resulting in significant loss to follow-up and biased estimates of mental health and its change. Here we report on time trends in key mental health indicators amongst Danish adults over the course of the pandemic (March 2020 - July 2021) focusing on subgroups defined by gender, age, and self-reported previously diagnosed chronic and/or mental illness. Methods We used time-series data collected by Epinion (N=8,261) with 43 timepoints between 20 March 2020 and 22 July 2021. Using a repeated cross-sectional study design, independent sets of individuals were asked to respond to the Copenhagen Corona-Related Mental Health questionnaire at each timepoint, and data was weighted to population proportions. The six mental health indicators examined were loneliness, anxiety, social isolation, quality of life, COVID-19-related worries, and the mental health scale. Gender, age, and the presence of previously diagnosed mental and/or chronic illness were used to stratify the population into subgroups for comparisons. Results Poorer mental health were observed during the strictest phases of the lockdowns, whereas better outcomes occurred during reopening phases. Women, young individuals (<34 yrs), and those with a mental- and/or chronic illness demonstrated poorer mean time-series than others. Those with a pre-existing mental illness further had a less reactive mental health time-series. The greatest differences between women/men and younger/older age groups were observed during the second lockdown. Conclusions People with mental illness have reported disadvantageous but stable levels of mental health indicators during the pandemic thus far, and they seem to be less affected by the factors that result in fluctuating time-series in other subgroups.