Artificial Intelligence and Human Rights: Are There Signs of an Emerging Discipline? A Systematic Review.

AIM: Our systematic review seeks to understand the linkages and reciprocal relationships between the artificial intelligence (AI) and human rights (HRs) and to unveil the signs of emergence of a new discipline at the crossroads of these two disciplines. BACKGROUND: AI and HRs have evolved in parallel as two fields, with AI technology engineers eventually interested in the consequences of their products on HRs, while more recently HRs experts have been exploring the benefits and threats of AI technologies on the protection and promotion of HRs. METHODS: A broad range of databases within the fields of legal sciences, social sciences, health-care sciences and the more general sciences practitioner base "Web of Science" were explored. Articles were selected according to strict inclusion/exclusion criteria and systematically analyzed regarding their content and authorship. RESULTS: The crossroad between AI and HRs is a dynamic field where researchers from different disciplines have been exploring issues such as autonomous lethal weapons, privacy protection, discriminatory decision-making in the insurance and finance systems, intellectual property, and legal personality of the robots. Signs of the emergence of a new discipline were identified. CONCLUSION: Identifying appropriate strategies to consolidate this emerging discipline seems necessary: one could be the development of academic programs at the crossroad of these two fields.

The Geneva University Global Health and Human Rights Summer School: A 5-Year Intercultural Collaborative Experience.

Education and training in human rights has been set as a priority by the United Nations. Health and human rights are closely related. Training professionals from various backgrounds in human rights might ultimately contribute to improve the health of individuals and communities. We present the 5 years' experience with a 3-week residential Global Health and Human Rights Course developed at the University of Geneva and implemented with the support/participation of international organizations (IOs) and non-governmental organizations active in the health and human rights sector. Over the years, roughly 150 students from 43 nationalities, with many different educational backgrounds, attended the course. The male/female ratio was 1/5. The adopted educational approach was multifold and comprised lectures from academics and experts with field experience, group work, individual case studies, journal clubs, and site visits. Evaluation data show that site visits at IOs were highly appreciated as well as networking opportunities among students, with academics and experts with field experience. The variety of topics discussed was, at times, "too much"; yet, it allowed students to measure the extent of the challenges the field is facing. The adopted active learning approach facilitated the exchange of experiences among students and allowed them to get acquainted with different cultural sensitivities. The Global Health and Human Rights Summer-School of the University of Geneva allowed its participants, coming from all over the world, to identify challenges of the interlinked fields of health and human rights, reflect upon their underlying causes, and imagine possible solutions. Sharing our experience will hopefully help passionate educators around the world to develop similar programs.

Health Priorities in French-Speaking Swiss Cantons.

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are "physical activity/sedentariness" and "nutrition/food." Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasible.

Training medical students in health promotion: twenty years of experience at the Faculty of Medicine of the University of Geneva.

Background: In most cases, the work of medical doctors, be they general practitioners or specialists, involves some dimension of health promotion (HP). There is thus ample justification for increasing the awareness of medical students vis-à-vis HP and its relevance for their future practice. Methods: In the context of a major curriculum reform (problem-based learning [PBL]) at the Faculty of Medicine of the University of Geneva in the mid-1990s, several steps were taken to strengthen HP throughout the curriculum and include HP in its key domains as defined by the Ottawa Charter (OC). Results: First, the political dimension of HP was developed in a series of first- and fifth-year lectures and third-year workshops; second, community action was strengthened through a third-year one-month community immersion program; third, the development of personal skills was integrated into second- and third-year PBL cases and into fourth-and fifth-year learning activities in clinical settings as well as second- and third-year HP electives; in terms of reorienting health services, the chosen approach included the development of a HP-specific track in the context of a Certificate of Advanced Studies (CAS) in Community Health and a Master of Advanced Studies(MAS) in Public Health. Furthermore, a supportive intra-university environment was created through a collaborative convention with Health Promotion Switzerland, which is in charge of coordinating HP in Switzerland. Conclusion: In our view, HP teaching for medical students seems all the more relevant given that future medical doctors will have to take care of an increasing number of patients likely to develop chronic non-communicable diseases.

Rape in Armed Conflicts in the Democratic Republic of Congo: A Systematic Review of the Scientific Literature.

We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words "rape and DRC" combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation.

Female genital mutilation: a systematic review of research on its economic and social impacts across four decades.

BACKGROUND: Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported. OBJECTIVE: This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice. DESIGN: A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011. RESULTS: One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%). CONCLUSIONS: The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.

Estimating the Costs of Torture: Challenges and Opportunities.

Due to its nature, extent and consequences, torture is considered a major public health problem and a serious violation of human rights. Our study aims to set the foundation for a theoretical framework of the costs related to torture. It examines existing challenges and proposes some solutions. Our proposed framework targets policy makers, human rights activists, professionals working in programmes, centres and rehabilitation projects, judges and lawyers, survivors of torture and their families and anyone involved in the prevention and fight against this practice and its consequences. We adopted a methodology previously used in studies investigating the challenges in measuring and valuing productivity costs in health disorders. We identify and discuss conceptual, methodological, political and ethical challenges that studies on the economic and social costs of torture pose and propose alternatives in terms of possible solutions to these challenges. The economic dimension of torture is rarely debated and integrated in research, policies and programmes. Several challenges such as epistemological, methodological, ethical or political ones have often been presented as obstacles to cost studies of torture and as an excuse for not investigating this dimension. In identifying, analysing and proposing solutions to these challenges, we intend to stimulate the integration of the economic dimension in research and prevention of torture strategies.

A public health e-learning master's programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience.

BACKGROUND: Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices. METHODS: A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored. RESULTS: The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects. CONCLUSIONS: Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

[International Health Electives in developing countries for medical and nursing students: four experiences from French-speaking Switzerland]. / Stages dans des pays en développement au cours des etudes de médecine. Eléments de littérature et réflexions basées sur quatre expériences en Suisse romande.

International Health Electives performed in developing countries by students of medical and nursing schools from industrialized nations have recently become a highly valued element in curricula of medical and nursing schools. We report here four examples of such electives developed over the years at the Faculties of medicine of Geneva and Lausanne, one involving both medical and nursing school students. These electives foster enthusiasm and commitment among students and host institutions abroad. A selective review of the literature highlights the many positive aspects of such electives for the professional and personal development of students. It also emphasizes what the host institutions can gain from these electives provided the latter are organized in a balanced partnership and that the students receive a careful preparation to avoid possible pitfalls.

[School-detected child abuse in Geneva: outlook on the past 10 years]. / Maltraitance repérée dans le cadre scolaire a Genéve: regard sur ces dix dernières années.

The Child and youth health service of the Canton of Geneva is an important actor in support of abused children attending school. Incidence of child abuse is stable at around 3.5 per 1,000 school children. Physical, psychological abuse and neglect are the types most frequently encountered. The main risk factors for abuse are precarious socio-economic situations, parenting issues and finally issues related to young people themselves. Although the incidence of abuse is stable in recent years, with respect to the growing number of children attending school, we can conclude that the absolute number of children at risk increases, confirming the need to develop and maintain common policies and prevention actions in this area.

Economic burden of torture for a refugee host country: development of a model and presentation of a country case study.

BACKGROUND: Torture is an important social and political problem worldwide that affects millions of people. Many host countries give victims of torture the status of refugee and take care of them as far as basic needs; health care, professional reinsertion, and education. Little is known about the costs of torture. However, this knowledge could serve as an additional argument for the prevention and social mobilization to fight against torture and to provide a powerful basis of advocacy for rehabilitation programs and judiciary claims. OBJECTIVES: Development of a model for estimating the economic costs of torture and applying the model to a specific country. METHODS: The estimation of the possible prevalence of victims of torture was based on a review of the literature. The identification of the socioeconomic factors to be considered was done by analogy with various health problems. The estimation of the loss of the productivity and of the economic burden of disease related to torture was done through the human capital approach and the component technique analysis. CASE STUDY: The model was applied to the situation in Switzerland of estimated torture victims Switzerland is confronted with. RESULTS: When applied to the case study, the direct costs - such as housing, food, and clothing - represent roughly 130 million Swiss francs (CHF) per year; whereas, health care costs amount to 16 million CHF per year, and the costs related to education of young people to 34 million CHF per year. Indirect costs, namely those costs related to the loss of the productivity of direct survivors of torture, have been estimated to one-third of 1 billion CHF per year. This jumps to 10,073,419,200 CHF in the loss of productivity if one would consider 30 years of loss per survivor. CONCLUSION: Our study shows that a rough estimation of the costs related to torture is possible with some prerequisites, such as access to social and economic indicators at the country level.

SMS reminders to improve the tuberculosis cure rate in developing countries (TB-SMS Cameroon): a protocol of a randomised control study.

BACKGROUND: Tuberculosis is a public health problem in Cameroon, just like in many other countries in the world. The National Tuberculosis Control Programme (PNLT) put in place by the state, aims to fight tuberculosis through the implementation of international directives (Directly Observed Treatment Short, DOTS). Despite the deployment of this strategy across the world, its implementation is difficult in the context of low-resource countries. Some expected results are not achieved. In Cameroon, the cure rate for patients with sputum positive pulmonary tuberculosis (TPM+) after 6 months is only about 65%, 20% below the target. This is mainly due to poor patient adherence to treatment. By relying on the potential of mobile Health, the objective of this study is to evaluate the effect of SMS reminders on the cure rate of TPM + patients, measured using 6-month bacilloscopy. METHODS/DESIGN: This is a blinded, randomised controlled multicentre study carried out in Cameroon. The research hypothesis is that sending daily SMS messages to remind patients to take their prescribed tuberculosis medication, together with the standard DOTS strategy, will increase the cure rate from 65% (control group: DOTS, no SMS intervention) to 85% (intervention group: DOTS, with SMS intervention) in a group of new TPM + patients. In accordance with each treatment centre, the participants will be randomly allocated into the two groups using a computer program: the intervention group and the control group. A member of the research team will send daily SMS messages. Study data will be collected by health professionals involved in the care of patients. Data analysis will be done by the intention-to-treat method. DISCUSSION: The achieving of expected outcomes by the PNLT through implementation of DOTS requires several challenges. Although it has been demonstrated that the DOTS strategy is effective in the fight against tuberculosis, its application remains difficult in developing countries. This study explores the potential of mHealth to support DOTS strategy. It will gather new evidence on the effectiveness of mHealth-based interventions and SMS reminders in the improvement of treatment adherence and the cure rate of tuberculosis patients, especially in a low-resource country such as Cameroon. TRIAL REGISTRATION: The trial is registered on the Pan-African Clinical Trials Registry (http://www.pactr.org) under unique identification number: PACTR201307000583416.

Testing an unconventional mortality information source in the canton of Geneva Switzerland.

Mortality data are often unavailable, incomplete, and difficult to access for research and other purposes. Gaps in mortality data reports, particularly those detailing place of death, deprive healthcare professionals, decision-makers, and many others of the information that is needed to plan, implement, and evaluate interventions designed for purposes such as to assist people in achieving their preferred death place or reduce hospital utilization. Alternative methods of collecting reliable and valid data on death place may be needed. Our study primarily compared mortality data from a conventional information system (Federal Statistical Office) with mortality data collected using an unconventional system (funeral homes) over a 6-year period (2005-10) for the canton of Geneva Switzerland. Only a small average difference (4.8%) in death incidence was found. Death place data comparisons were also useful. This study suggests that the unconventional data from funeral homes provides reasonably reliable, valid, timely, and useful mortality data.

Computer literacy and E-learning perception in Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences.

BACKGROUND: Health science education faces numerous challenges: assimilation of knowledge, management of increasing numbers of learners or changes in educational models and methodologies. With the emergence of e-learning, the use of information and communication technologies (ICT) and Internet to improve teaching and learning in health science training institutions has become a crucial issue for low and middle income countries, including sub-Saharan Africa. In this perspective, the Faculty of Medicine and Biomedical Sciences (FMBS) of Yaoundé has played a pioneering role in Cameroon in making significant efforts to improve students' and lecturers' access to computers and to Internet on its campus.The objective is to investigate how computer literacy and the perception towards e-learning and its potential could contribute to the learning and teaching process within the FMBS academic community. METHOD: A cross-sectional survey was carried out among students, residents and lecturers. The data was gathered through a written questionnaire distributed at FMBS campus and analysed with routine statistical software. RESULTS: 307 participants answered the questionnaire: 218 students, 57 residents and 32 lecturers. Results show that most students, residents and lecturers have access to computers and Internet, although students' access is mainly at home for computers and at cyber cafés for Internet. Most of the participants have a fairly good mastery of ICT. However, some basic rules of good practices concerning the use of ICT in the health domain were still not well known. Google is the most frequently used engine to retrieve health literature for all participants; only 7% of students and 16% of residents have heard about Medical Subject Headings (MeSH).The potential of e-learning in the improvement of teaching and learning still remains insufficiently exploited. About two thirds of the students are not familiar with the concept of e-leaning. 84% of students and 58% of residents had never had access to e-learning resources. However, most of the participants perceive the potential of e-learning for learning and teaching, and are in favour of its development at the FMBS. CONCLUSION: The strong interest revealed by the study participants to adopt and follow-up the development of e-learning, opens new perspectives to a faculty like the FMBS, located in a country with limited resources. However, the success of its development will depend on different factors: the definition of an e-learning strategy, the implementation of concrete measures and the adoption of a more active and participative pedagogy.

[Community immersion program at Geneva medical school: a fifteen-year experience]. / Immersion en communauté au cours des etudes de médecine a Genève: un bilan a quinze ans.

Over the past decades there have been many new developments in medical education due to new public health challenges and to new learning theories. Medical schools throughout the world have adapted to these challenges in adopting community-based learning activities, an approach that the World Health Organization has promoted. The aim of the present article is to describe the characteristics, as well as the evolution, of such a community-based training program which has been implemented over 15 years at the Faculty of medicine of the University of Geneva and to present some evaluation data addressing students' perception, achievement of learning objectives as well as interactions between students and the community.

Alumni evaluation of a community-oriented master of public health program.

Health workforce development is a public health priority for the World Health Organization. Public Health training programs need to be relevant in a public health perspective and efficient in and educational perspective. This implies evaluating the programs: in this regard student's perception might be interesting, or the opinion of external experts, or the experience of alumni. To study the perception of alumni of a master's program in public health in order to reevaluate the goals and objectives of the program, a cross-sectional survey through a self-administered questionnaire among former students that graduated from the Geneva University Master in Public Health program was done. This self-administered questionnaire included closed questions on a Likert five-point scale for regarding the use at work of tools acquired during the course, as well as open questions. Overall the alumni gave a positive evaluation of the course. As strong points were mentioned: networking opportunities, student-centered approach and multi-professional background of the student body. More critically judged were: tutorship, time constraints and costs. As most useful tools in their professional settings alumni mentioned: communication skills, project evaluation competencies and literature search strategies and again networking which in this case seemed to be quite active. Evaluation surveys among alumni allow reevaluation of the program's goals and objectives in the light of their professional needs.

Health workforce development: a needs assessment study in French speaking African countries.

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation's health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.