Marta Fadda

During the COVID-19 pandemic, Switzerland prioritized vaccination for school staff to mitigate the economic and societal impacts of school closures. However, there is limited research on vaccine acceptance and hesitancy among school staff in Switzerland. This study aimed to explore the arguments used by school staff to justify COVID-19 vaccination decisions in public and private institutions across Switzerland's German-, French-, and Italian-speaking regions. Participants were recruited using purposive sampling from a national survey and through snowball techniques. Data were collected from interviews with 47 participants employed in nurseries, kindergartens, primary schools, middle schools, and special education facilities, conducted between November 2021 and March 2022. Interviews were analyzed using a primarily inductive approach, complemented by elements of abductive and deductive reasoning to identify key principles guiding decision-making. Among the participants, 36 had received at least one dose of the COVID-19 vaccine, while 11 remained unvaccinated. We extracted four main themes: respondents considered four principles (i.e. self-protection, protection of others, return to normality, and institutional loyalty) as starting points in their decision-making process and then developed different arguments, either in support or against vaccination. The findings illustrate the complexity of vaccine hesitancy within the school context, where individual decisions are shaped by a combination of rational, moral, political and identity-related factors. This study contributes to the theoretical understanding of vaccination decision-making processes, particularly in school settings. It highlights the importance of considering vaccine hesitancy in the workplace and underscores the need for tailored communication strategies that address specific concerns within professional groups.

The question of whether clinical ethicists should be informed of case resolutions remains unresolved. While the American Society for Bioethics and Humanities (ASBH) recommends retrospective case reviews to assess whether recommendations were followed, it frames this practice solely as a quality improvement measure. While quality enhancement is a compelling rationale for ensuring that clinical ethicists are informed of the resolutions of consultations, it is not the sole justification for such transparency. Access to case resolutions strengthens ethics education, enhances accountability and transparency, facilitates contributions to the field and advocacy, and mitigates the emotional uncertainty that can arise when ethicists lack closure on complex cases. Although concerns about confidentiality and administrative constraints must be considered, they should not hinder efforts to foster a more transparent consultation process.

To reduce the spread of COVID-19, schools closed and moved to remote learning in many countries and municipalities. At the time of this study, Switzerland maintained the position that schools should be prioritized to remain open. The state of knowledge regarding the challenges that school staff encountered during the pandemic was limited. The aim of this study was to qualitatively explore the impact of COVID-19 and related measures in Switzerland on the professional life of school staff in terms of challenges, strategies, and benefits. Data were collected between November 2021 and March 2022. We conducted interviews with 47 participants working in nurseries, kindergartens, primary, middle, special, and after-schools across Switzerland. The majority were women and part of the teaching staff. Most had received at least one dose of the COVID-19 vaccine. Participants reported various challenges such as isolation, loneliness, and ‘dryness’ of work, pedagogical alienation and deontological distress, privacy loss, and confusion regarding health measures. They also cited different strategies, namely resuming simple activities, finding the right degree of transgression, recreating normality with children, and continuous adaptation. Finally, they identified some benefits, i.e. improvements in education regarding hygiene standards, greater acceptance of illness and death as a normal part of life, recognition of the privilege of being able to attend school in-person, and valorization of cultural diversity. We highlight the importance of listening to staff’s concerns, enacted strategies, and perceived benefits and taking them into account when developing appropriate and effective public health and communication efforts.

Despite cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) decisions are increasingly considered an essential component of hospital practice and patient inclusion in these conversations an ethical imperative in most cases, there is evidence that such discussions between physicians and patients/surrogate decision-makers (the person or people providing direction in decision making if a person is unable to make decisions about personal health care, e.g., family members or friends) are often inadequate, excessively delayed, or absent. We conducted a study to qualitatively explore physician-reported CPR/DNAR decision-making approaches and CPR/DNAR conversations with patients hospitalized in the internal medicine wards of the four main hospitals in Ticino, Southern Switzerland. We conducted four focus groups with 19 resident and staff physicians employed in the internal medicine unit of the four public hospitals in Ticino. Questions aimed to elicit participants’ specific experiences in deciding on and discussing CPR/DNAR with patients and their families, the stakeholders (ideally) involved in the discussion, and their responsibilities. We found that participants experienced two main tensions. On the one side, CPR/DNAR decisions were dominated by the belief that patient involvement is often pointless, even though participants favored a shared decision-making approach. On the other, despite aiming at a non-manipulative conversation, participants were aware that most CPR/DNAR conversations are characterized by a nudging communicative approach where the physician gently pushes patients towards his/her recommendation. Participants identified structural cause to the previous two tensions that go beyond the patient-physician relationship. CPR/DNAR decisions are examples of best interests assessments at the end of life. Such assessments represent value judgments that cannot be validly ascertained without patient input. CPR/DNAR conversations should be regarded as complex interventions that need to be thoroughly and regularly taught, in a manner similar to technical interventions.

Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to “share” meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians’ experiences of SDM in the management of paediatric patients with prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians’ SDM approaches, representations, and ethical justifications for engaging in SDM. We used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis. We found that participants followed three main decision-making approaches: the “brakes” approach, characterized by maximized family’s decisional freedom, though conditional to physician’s judgment regarding the medical appropriateness of a treatment; the “orchestra director” approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the “sunbeams” approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians’ virtues to guide the decision-making process. Our results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient’s autonomy as its only moral foundation.

Objectives: The COVID-19 pandemic continues, and evidence on infection- and vaccine-induced immunity is key. We assessed COVID-19 immunity and the neutralizing antibody response to virus variants across age groups in the Swiss population. Study Design: We conducted a cohort study in representative community-dwelling residents aged five years or older in southern Switzerland (total population 353,343), and we collected blood samples in July 2020 (in adults only, N = 646), November–December 2020 (N = 1457), and June–July 2021 (N = 885). Methods: We used a previously validated Luminex assay to measure antibodies targeting the spike (S) and the nucleocapsid (N) proteins of the virus and a high-throughput cell-free neutralization assay optimized for multiple spike protein variants. We calculated seroprevalence with a Bayesian logistic regression model accounting for the population’s sociodemographic structure and the test performance, and we compared the neutralizing activity between vaccinated and convalescent participants across virus variants. Results: The overall seroprevalence was 7.8% (95% CI: 5.4–10.4) by July 2020 and 20.2% (16.4–24.4) by December 2020. By July 2021, the overall seroprevalence increased substantially to 72.5% (69.1–76.4), with the highest estimates of 95.6% (92.8–97.8) among older adults, who developed up to 10.3 more antibodies via vaccination than after infection compared to 3.7 times more in adults. The neutralizing activity was significantly higher for vaccine-induced than infection-induced antibodies for all virus variants (all p values < 0.037). Conclusions: Vaccination chiefly contributed to the reduction in immunonaive individuals, particularly those in older age groups. Our findings on the greater neutralizing activity of vaccine-induced antibodies than infection-induced antibodies are greatly informative for future vaccination campaigns.

The emergence of big data science presents a unique opportunity to improve public-health research practices. Because working with big data is inherently complex, big data research must be clear and transparent to avoid reproducibility issues and positively impact population health. Timely implementation of solution-focused approaches is critical as new data sources and methods take root in public-health research, including urban public health and digital epidemiology. This commentary highlights methodological and analytic approaches that can reduce research waste and improve the reproducibility and replicability of big data research in public health. The recommendations described in this commentary, including a focus on practices, publication norms, and education, are neither exhaustive nor unique to big data, but, nonetheless, implementing them can broadly improve public-health research. Clearly defined and openly shared guidelines will not only improve the quality of current research practices but also initiate change at multiple levels: the individual level, the institutional level, and the international level.

Objectives: The aim of this scoping review was to map out the existing evidence of the impact of the COVID-19 lockdown on parents of children and adolescents. We sought to: 1) identify parenting domains that were particularly affected by lockdown measures, 2) describe the challenges and opportunities of lockdown measures in these domains, and 3) define protective and exacerbating factors modulating the effect of lockdown measures on parents.Methods: We identified five main domains investigated in the context of parenting during the early COVID-19 lockdown derived from 84 studies: health and wellbeing, parental role, couple functioning, family and social relationships, and paid and unpaid work. For each domain, we listed challenges and opportunities, as well as discriminant factors.Results: The lockdown impacted all five different but interconnected domains, introduced new roles in parents’ lives, and particularly affected women and vulnerable populations.Conclusion: This scoping review highlights the importance of approaching public health policymaking from a social justice perspective. Such an approach argues for social and public health policies to promote health accounting for its social, economic, political, and commercial determinants.