Josip Car

King's College London | KCL · School of Life Course and Population Sciences

Background Global pandemics like COVID-19 put a high amount of strain on health care systems and health workers worldwide. These crises generate a vast amount of news information published online across the globe. This extensive corpus of articles has the potential to provide valuable insights into the nature of ongoing events and guide interventio...

Background Cardiovascular diseases (CVDs) are among the leading causes of mortality and morbidity globally, with an estimated 1 million hospital admissions for CVD in England in 2019/20, leading to 5.5 million bed days. In addition, patients with CVDs have a notably high rate of hospital readmission, with approximately one in four patients experien...

Background As numerous studies highlighted the importance of maintaining proper foot care (FC) behaviours among individuals with diabetes to prevent complications, we sought to assess FC behaviours among patients with diabetes and to identify the factors associated with the practice of diabetic FC. Methods We used a cross-sectional design and coll...

BACKGROUND Virtual consultations represent a notable change in healthcare delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing healthcare system resilience and adaptability in times of crisis. OBJECTIVE (1) To describe the availability and hours of use of telephone, video and human...

Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and suppor...

Objective Sleep quality is a crucial concern, particularly among youth. The integration of health coaching with question-answering (QA) systems presents the potential to foster behavioural changes and enhance health outcomes. This study proposes a novel human-AI sleep coaching model, combining health coaching by peers and a QA system, and assesses...

Background Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most hea...

With the rise of generative artificial intelligence (AI) and AI-powered chatbots, the landscape of medicine and healthcare is on the brink of significant transformation. This perspective delves into the prospective influence of AI on medical education, residency training and the continuing education of attending physicians or consultants. We begin...

BACKGROUND Digital health is a critical driver of quality, safety, and efficiency in healthcare. However, poor quality of clinical information in Digital Health Technologies (DHTs) can compromise the quality and safety of care. The Clinical Information Quality (CLIQ) framework was developed as a pragmatic tool to assess the quality of clinical info...

Background Depression is a common issue among university students and has been particularly exacerbated during the COVID-19 pandemic. However, limited research has specifically focused on depression among university entrants. Objectives This study aimed to determine the prevalence of depression severity and identify associated factors during diffe...

UNSTRUCTURED Global pandemics like COVID-19 put high strain on healthcare systems and health workers around the world, potentially leading to industrial actions from workers. Such events generate plethora of news information published online by news outlets in each country. Processing the information contained in these news articles yields valuable...

Background Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wou...

Background: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptua...

BACKGROUND To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support...

Objective Wound image analysis tools hold promise in helping patients to monitor their wounds. We aim to perform a novel feasibility study on the efficacy of a patient-owned wound surveillance system for diabetic foot ulcer (DFU) care. Methods This two-institutional, prospective, single-arm pilot study examined patients with DFU. An artificial int...

Digital health technologies have been in use for many years in a wide spectrum of healthcare scenarios. This narrative review outlines the current use and the future strategies and significance of digital health technologies in modern healthcare applications. It covers the current state of the scientific field (delineating major strengths, limitati...

BACKGROUND Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wou...

Background Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their association...

BACKGROUND Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in healthcare settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes, and unreliable research findings. We developed and published a conceptual...

BACKGROUND Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence Primary Care Phys...

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimat...

Objective Digital health has recently gained a foothold in monitoring and improving diabetes care. We aim to explore the views of patients, carers and healthcare providers (HCPs) regarding the use of a novel patient-owned wound surveillance application as part of outpatient management of patients with diabetic foot ulcers (DFUs). Methods Semi-stru...

Non-communicable diseases (NCDs) are a leading cause of global deaths, necessitating a focus on primary prevention and lifestyle behavior change. Health coaching, coupled with Question Answering (QA) systems, has the potential to transform preventive healthcare. This paper presents a human-Artificial Intelligence (AI) health coaching model incorpor...

BACKGROUND Health apps are increasingly seen as key to supporting healthcare delivery in its various aspects from communication, patient education, and decision support to self-management. For all countries and especially low- and middle-income ones including those in sub-Saharan Africa (SSA), health apps could play a vital role. However, most heal...

Background: Digital education has expanded since the COVID-19 pandemic began. A substantial amount of recent data on how students learn has become available for learning analytics (LA). LA denotes the "measurement, collection, analysis, and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning a...

Background Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, “LvL UP...

Objectives: Venous leg ulcers (VLU) are both chronic and recurrent. Treatment of such ulcers often require multiple outpatient visits and dressings. Several reports on the costs of treating such VLUs have been reported in the west. We aim to prospectively evaluate the clinical and economic burden of VLUs in a population of Asian patients in the tr...

Low-quality data can cause downstream problems in high-stakes applications. Data-centric approach emphasizes on improving dataset quality to enhance model performance. High-quality datasets are needed for general-purpose Large Language Models (LLMs) training, as well as for domain-specific models, which are usually small in size as it is costly to...

Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-res...

Background Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and health...

BACKGROUND Mental disorders cause substantial health-related burden worldwide. Mobile health (mHealth) interventions are increasingly used for the promotion of mental health and well-being, as they have the potential to improve access to treatment and reduce associated costs. Behaviour change is an important feature of interventions aimed at improv...

Background: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-be...

Background Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and health...

Background The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarce...

BACKGROUND Type 2 diabetes is becoming more prevalent around the world, including in Singapore. Diabetes education programs have been proven to be effective in improving health outcomes and diabetes self-management skills. Several effective approaches to diabetes education in patients with type 2 diabetes have been established, including the use of...

Background Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population...

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across S...

This research investigated the overall and domain-specific physical activity (PA) of university students in the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study was applied to socioeconomic (SE) and PA online data collected from 15,366 students across 17 universities in seven Association of Southeast Asian Nations (ASEAN) count...

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter‐institutional and multi‐disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster ‐ an in...

Objectives: We examined the combined effects of behavioural inhibition and behavioural activation, on one hand, and locus of control, on the other hand, on different categories of smoking behaviour (non-smoking, ex-smoking, occasional smoking, daily smoking). Design: This study adopted a cross-sectional design. Participants completed questionnaire...

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehens...

Background This study investigated, through cluster analysis, the associations between behavioural characteristics, mental wellbeing, demographic characteristics, and health among university students in the Association of Southeast Asian Nations (ASEAN) University Network – Health Promotion Network (AUN-HPN) member universities. Methods Data were...

As part of a larger study to design a clinical decision support system for automated ASA classification, we sought to measure inter-rater agreement in ASA scores assigned by anaesthesia providers to cases commonly encountered in a Singapore tertiary women's hospital. We also examined the relationship between ASA agreement and clinical experience.

Background Conversational agents (CAs) or chatbots are increasingly used for depression, anxiety, and wellbeing management. CAs are considered acceptable and helpful. However, little is known about the adequacy of CA responses. This study assessed the structure, content, and user-customization of mental health CA dialogues for users managing depres...

Background: The extension to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individuals and systems digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. Digital maturity in primary care has been scarcely ev...

BACKGROUND Digital Health Technologies (DHTs), such as electronic health records and prescribing systems, are transforming healthcare delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel Clinical Information Quality (CLIQ) Framework to assess the quality of clinical information...

Background: Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical informat...

BACKGROUND Digital education has expanded since the COVID-19 pandemic began. A substantial amount of recent data on how students learn has become available for learning analytics (LA). LA denotes the “measurement, collection, analysis, and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and...

The prevalence of epidemiological health-risk behaviors and mental well-being in the COVID-19 pandemic, stratified by sociodemographic factors in Association of South East Asian Nations (ASEAN) university students, were examined in the research. Data were collected in March-June 2021 via an online survey from 15,366 university students from 17 univ...

Background Integrating healthcare services across and between the different health system levels can be achieved in a few ways; however, examining the social side of integration is essential and challenging. This paper explores the concept of integration perceived by general practitioners (GPs) and primary care network (PCN) representatives from th...

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits...

Cognitive fatigue is a mental state characterised by feelings of tiredness and impaired cognitive functioning due to sustained cognitive demands. Frequency-domain heart rate variability (HRV) features have been found to vary as a function of cognitive fatigue. However, it has yet to be determined whether HRV features derived from electrocardiogram...

Background Narrative e-Writing Intervention (NeW-I) is a novel psycho-socio-spiritual intervention which aims to bridge gaps in paediatric palliative care by providing anticipatory grief support to parent-caregivers who are looking after their child with a chronic life-threatening illness in Singapore. This is done via a therapist-facilitated smart...

Introduction: Digital health technologies (DHTs) such as electronic health records, clinical decision support systems and electronic prescribing systems are widely used in healthcare. While adoption of DHTs can improve healthcare delivery, information quality (IQ) problems associated with DHTs can compromise quality and safety of care. The clinica...

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Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. Design Systematic analysis. Setting Participants were aged ≥70 from 204 countries and terri...

An abundant and growing supply of digital health applications (apps) exists in the commercial tech-sector, which can be bewildering for clinicians, patients, and payers. A growing challenge for the health care system is therefore to facilitate the identification of safe and effective apps for health care practitioners and patients to generate the m...

Introduction Despite health applications becoming ubiquitous and with enormous potential to facilitate self-management, regulatory challenges such as poor application quality, breach of data privacy and limited interoperability have impeded their full adoption. While many countries now have digital health-related policies/strategies, there is also...

Background: The American Society of Anesthesiologists (ASA) score is generated, based on patients' clinical status. Accurate ASA classification is essential for the communication of perioperative risks and resource planning. The literature suggests that ASA classification can be automated for consistency and time-efficiency. To develop a rule-base...

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocia...

Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health-related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio-demogr...