Investigating Tetanus, Diphtheria, Acellular Pertussis Vaccination During Pregnancy and Risk of Congenital Anomalies.

INTRODUCTION: This observational retrospective matched cohort study evaluated the safety of a prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination, Boostrix. We previously reported on the risk of maternal and neonatal outcomes; here we report on the risk of congenital anomalies in infants at birth through 6 months of age. METHODS: The study included pregnant Kaiser Permanente Southern California members. Women who received the Tdap vaccine on or after the 27th week of pregnancy between January 2018 and January 2019 were matched to women who were pregnant between January 2012 and December 2014 and were not vaccinated with Tdap during pregnancy. Unadjusted and adjusted relative risks (aRRs) with 95% confidence intervals were estimated by Poisson regression. Quantitative secular trend analyses, from 2011 to 2017, were conducted on congenital anomalies with a statistically significant aRR > 1. RESULTS: The analysis consisted of 16,350 and 16,088 live-born infants in the Tdap-exposed and unexposed cohorts, respectively. Of the 14 congenital anomaly body systems evaluated, 8 (eye, ear/face/neck, respiratory, upper gastrointestinal, genital, renal, musculoskeletal, integument) had statistically significant elevated aRRs, with point estimates ranging from 1.17 to 2.02. The observed elevated aRRs were consistent with their respective secular increases over time. CONCLUSION: Cautious interpretation of these findings is warranted as these increases may have resulted from improved identification and diagnosis. Furthermore, the biological plausibility of an association between maternal vaccine exposure in the third trimester of pregnancy and birth defects is low. The overall study findings support the safety of maternal immunization with Boostrix during the third trimester of pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03463577.

Safety of tetanus, diphtheria, acellular pertussis (Tdap) vaccination during pregnancy.

The objective of this study was to evaluate the safety of prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination. This cohort study was conducted among pregnant members at Kaiser Permanente Southern California (KPSC). The exposed cohort consisted of women who received Tdap vaccine on or after the 27th week of pregnancy between January 2018 and January 2019. The unexposed cohort consisted of matched women who were pregnant between January 2012 and December 2014 and were not vaccinated with any Tdap vaccine throughout their pregnancy. Maternal and infant characteristics and pre-specified endpoints were collected through automated data and review of the electronic health records. Unadjusted and adjusted relative risks (aRRs) with confidence intervals (CIs) were estimated by Poisson regression. Non-inferiority testing (i.e., to rule out a two-fold increase) was conducted for primary endpoints with adjustment for multiplicity. Superiority testing was conducted without multiplicity adjustment for secondary endpoints. The analysis consisted of 16,606 pairs of Tdap recipients and unexposed pregnant women. For the primary endpoints, the aRR for preeclampsia/eclampsia was 1.38 (98.75% CI:1.21-1.58) and the aRR for intrauterine infection was 1.28 (98.75% CI:1.12-1.47). These increases were consistent with the background increasing trend of these diagnoses among all pregnant women at KPSC since 2011, and the upper limit of the 98.75% CI of both aRRs did not exceed the pre-specified threshold of 2. No increased risks of small for gestational age (aRR = 1.04, 98.75% CI:0.94-1.16) or preterm delivery (aRR = 0.71, 98.75% CI:0.64-0.78) were observed. No evidence of increased risks for secondary endpoints, including poor fetal growth, preterm pre-labor rupture of membranes, stillbirth/fetal death, placental abruption, transfusion during delivery hospitalization, and neonatal death, was observed. Prenatal Tdap vaccination after the 27th week of pregnancy was not associated with increased risks of pre-specified maternal and infant outcomes, supporting the safety of Tdap vaccination during pregnancy.

Interventions for the treatment of xerostomia: A randomized controlled clinical trial.

BACKGROUND: Xerostomia or dry mouth sensation corresponds to a common clinical problem that can significantly impair the oral health related quality of life (OHRQoL). Currently, there is a large variety of local agents available for the treatment of xerostomia, but there is a lack robust evidence supporting the use of one treatment over another. We aimed to compare the effectiveness of a 1% malic acid salivary stimulant spray with a 1.33% betaine-based saliva substitute mouthwash in the improvement of xerostomia. MATERIAL AND METHODS: Fifty-one participants with drug induced or idiopathic xerostomia were randomly allocated into three groups, two intervention and one control group (placebo). OHRQoL and severity of xerostomia were assessed with the OHIP-14sp questionnaire and a visual analogue scale (VAS) respectively. Stimulated and non-stimulated salivary flow rates before and after treatments were also measured. RESULTS: All three groups reported a significantly improvement in the dry mouth sensation and non-stimulated salivary flow rates, but only the malic acid spray and the betaine-based mouthwash significantly improved the OHRQoL. There were no significant differences between both intervention groups. CONCLUSIONS: This study provides evidence that both tested agents are comparable in improving the dry mouth sensation and OHRQoL of patients with drug induced and idiopathic xerostomia. Key words:Xerostomia, dry mouth, malic acid, betaine, oral-health related quality of life.

Efecto Inhibitorio de fracciones polifenolicas de la semilla de Persea americana var. Hass sobre el crecimiento de Helicobacter pylori / Inhibitory effect of seed polyphenolic fractions of Persea americana var. Hass on the Helicobacter pylori growth

ntroducción: El cáncer gástrico (CG) es la principal causa de muerte por cáncer en Colombia y de etiología multifactorial, asociada a factores genéticos del huésped, factores ambientales y el oncopatogeno Helicobacter pylori (H. pylori) como el principal factor de riesgo de la enfermedad. El aguacate (Persea americana var. Hass, (P. americana)) posee un alto contenido de polifenoles, con actividad bactericida, antioxidante, anti-ureasa, y antinflamatoria, que a su vez limitan los cambios en el ambiente gástrico que favorecen la colonización de la bacteria y posterior desencadenamiento de la cascada precancerosa. Objetivo: Evaluar la concentración mínima inhibitoria de fracciones polifenolicas de la semilla de P. americana sobre el crecimiento in vitro de H pylori. Resultados: La evaluación de la concentración mínima inhibitoria (CMI) de las tres fracciones obtenidas de la semilla de P. americana en cultivo de H. pylori in vitro, mostró que las fracciones uno y dos inhibieron el crecimiento bacteriano a 3000 ppm, mientras que la fracción 3 a 1500 ppm, P< 0,05. Conclusión: Se encontraron tres biofracciones polifenolicas de la semilla P. americana, principalmente constituidas por procianidinas, con actividad antibacterial in vitro de Helicobacter pylori, sin embargo, la fracción tres, de mayor peso molecular, inhibió el crecimiento de manera significativa a una CMI de 1500 ppm, comparada con las fracciones uno y dos.

Introduction: Gastric cancer (GC) is the main cause of cancer death in Colombia and of multifactorial etiology, associated with genetic factors of the host, environmental factors and the oncopathogen Helicobacter pylori (H. pylori) as the main risk factor of the disease. The avocado (Persea americana var. Hass, (P. americana)) has a high content of polyphenols, with bactericidal, antioxidant, anti-urease, and anti-inflammatory activity, which in turn limit changes in the gastric environment that favor colonization bacteria and subsequent triggering of the precancerous cascade. Objective: To evaluate the minimum inhibitory concentration of polyphenolic fractions of P. americana seed on the in vitro growth of H pylori. Results: The evaluation of the minimum inhibitory concentration (MIC) of the three fractions obtained from the P. americana seed in H. pylori culture in vitro, showed that fractions one and two inhibited bacterial growth at 3000 ppm, while fraction 3 at 1500 ppm, P <0.05. Conclusion: Three polyphenolic biofractions of the P. americana seed were found, mainly constituted by procyanidins, with in vitro antibacterial activity of Helicobacter pylori, however, fraction three, with a higher molecular weight, significantly inhibited growth at a MIC of 1500 ppm, compared to fractions one and two.

Factores peri y postnatales relacionados con el asma bronquial en niños / Perinatal and Postnatal Factors Related with Bronchial Asthma in Pinar del Río Children

Introducción: el asma es una de las enfermedades que recuerda a los médicos la importancia de los elementos clínicos y epidemiológicos en el reconocimiento del paciente. La enfermedad surge por factores genéticos y ambientales. Objetivo: describir los factores peri y postnatales del asma bronquial en pacientes de edad pediátrica en Pinar del Río. Material y método: se realizó un estudio descriptivo en la provincia Pinar del Río durante el periodo enero-junio 2010. Fueron seleccionados 585 asmáticos de edad pediátrica, por muestreo probabilístico estratificado, proporcional al universo de pacientes de las capitales municipales. Se consideró a cada municipio como estrato. Se usó la técnica de muestreo sistemático. Se calcularon las frecuencias absolutas y relativas de las variables cualitativas estudiadas. Resultados: el 10.8% de las madres fueron fumadoras durante el embarazo. El 6.7% y 39.5% de los niños fueron fumadores activos y pasivos respectivamente. El 34.2% de los niños asmáticos no mantuvo lactancia materna exclusiva hasta los tres meses. La rinitis ocupó el primer lugar (55%) dentro de las co-morbilidades alérgicas. El 73.2% de los pacientes presentaron catarros, seguido de las amigdalitis e infecciones parasitarias. Conclusiones: el tabaquismo (pasivo y activo), la convivencia con animales domésticos, el consumo excesivo y temprano de leche de vaca con el retiro temprano de la lactancia materna exclusiva y las infecciones respiratorias como antecedentes patológicos personales constituyen factores peri y postnatales relacionados con niños asmáticos en Pinar del Río en quienes la rinitis y dermatitis se asociaron como parte de la marcha atópica.

Introduction: asthma is a disease that reminds physicians of the importance of clinical and epidemiological elements in the patient’s recognition. The disease appears by genetic and environmental factors. Objective: to describe the perinatal and postnatal factors for bronchial asthma in Pinar del Río pediatric patients. Material and method: a descriptive study was conducted in Pinar del Rio Province during the period from January to June 2010. 585 asthmatic patients in pediatric ages were chosen, by stratified probability sampling, proportional to the patient population of the province’s towns. We considered each municipality as stratum. The systematic sampling technique was used. The absolute and relative frequencies of the studied qualitative variables were calculated. Results: 10.8% of the mothers were smokers during pregnancy. 6.7% and 39.5% of the children were active and passive smokers, respectively. 34.2% of asthmatic children maintained exclusive breastfeeding up to three months. Rhinitis ranked first (55%) amongst allergic co-morbidities. 73.2% of the patients had colds, followed by tonsillitis and parasitic infections. Conclusions: smoking (passive and active), living with pets, early and excessive consumption of cow's milk with the early retirement of exclusive breastfeeding, and respiratory infections, as part of the patient’s personal medical history, constitute altogether perinatal and postnatal factors related with the existence of asthmatic children in Pinar the Río, in which rhinitis and dermatitis were associated as part of the atopic natural history.

Influencia del sedentarismo y la dieta inadecuada en la salud de la población pinareña / Influence of physical inactivity and poor diet on the health of the population of Pinar del Rio

Introducción: el estilo de vida se fundamenta en la interacción entre las condiciones de vida y los patrones individuales de conducta. El sedentarismo y la dieta inadecuada son ejemplos de factores que influyen en el estado de salud de la población. Objetivo: determinar la influencia del sedentarismo y la dieta inadecuada en la salud de la población pinareña. Método: se realizó un estudio de prevalencia observacional analítico de corte transversal en el municipio Pinar del Río, durante el año 2010. El universo estuvo constituido por 148568 individuos de uno u otro sexo, de 15 a 74 años, la muestra por 2515 seleccionados mediante un diseño muestral complejo, estratificado por conglomerados polietápico. Para obtener la información se utilizó el instrumento diseñado para la vigilancia de factores de riesgo de enfermedades crónicas en su versión panamericana STEPS. El procesamiento y análisis de los resultados, se realizó con el paquete estadístico SPSS para el diseño de muestras complejas. Resultados: en sedentarios fue superior el por ciento de hipertensión (35.8%), sobrepeso y obesidad (47.5%), hipercolesterolemia (14.2%), diabetes (10.9%), consumo de alcohol (9.8%) y filtrado glomerular por debajo de 60 ml/min (18.8%). Estos se asociaron estadística y significativamente con el sedentarismo. En individuos con dieta inadecuada fue superior el por ciento de hipertensión (35%), sobrepeso y obesidad (47.1%), hipercolesterolemia (13.4%), hipertrigliceridemia (13.9%), diabetes (10.1%), perímetro de cintura alto (35%) y filtrado glomerular por debajo de 60 ml/min (16.6%). Conclusiones: el sedentarismo y la dieta inadecuada influyeron en la salud de la población pinareña estudiada.

Introduction: Lifestyle is based on the interaction between living conditions and individual behavior patterns. Physical inactivity and poor diet are examples of factors influencing the health status of the population. Objective: to determine the influence of physical inactivity and poor diet on the health of the population of Pinar del Rio. Method: an observational analytical cross-sectional study of prevalence was carried out in Pinar del Río Municipality in 2010. The universe consisted of 148 568 individuals of both sexes, 15 to 74 years old, the sample was 2515 individuals chosen by a complex sampling design, stratified by multistage clusters. For information we used the instrument designed for monitoring risk factors for chronic diseases in the Pan American STEPS version. The processing and analysis of the results was performed with the SPSS statistical package for the design of complex samples. Results: in sedentary individuals the percentage of hypertension (35.8%) was higher, as well as overweight and obesity (47.5%), hypercholesterolemia (14.2%), diabetes (10.9%), alcohol (9.8%), and glomerular filtration rate below 60 ml/min (18.8%) . These were statistically associated with physical inactivity. In individuals with inadequate diet some data were higher: the percentage of hypertension (35%), overweight and obesity (47.1%), hypercholesterolemia (13.4%), hypertriglyceridemia (13.9%), diabetes (10.1%), high waist circumference (35%) and glomerular filtration rate below 60 ml/min (16.6%). Conclusions: physical inactivity and poor diet influenced the health of the Pinar del Rio population studied.

Cólera: historia y actualidad / Cholera: history and present

Se revisó la bibliografía actualizada sobre el tema a partir de los principales buscadores, y reuniones internacionales realizadas sobre las pandemias de cólera. Se tratan los aspectos relacionados con la historia, aparición de la pandemia, la biología de la enfermedad, epidemiología, el cuadro clínico, tratamiento y el pronóstico y la prevención. El cólera es un infección intestinal aguda causada por la ingestión de Vibrio cholerae, una bacteria presente en aguas y alimentos contaminados por heces fecales, que suele transmitirse a través de estos, y sigue constituyendo un riesgo permanente en muchos países. El riesgo mayor se registra en las comunidades y los entornos sobrepoblados, donde el saneamiento es deficiente; sin embargo, ante una comunidad preparada y con tratamiento oportuno, la letalidad no sobrepasa el 1%. Las manifestaciones clínicas pueden ser leves, moderadas o graves, el tratamiento de elección es la doxiciclina, pero el más importante es el de la deshidratación. Solo se usa antibióticos en los casos graves. Es indispensable la adecuada educación sanitaria de la población y el tratamiento del agua de consumo y de los alimentos, además de la disposición adecuada de residuales.

Current medical literature about the theme was reviewed from the main web searching engines, and from international meetings concerning cholera pandemics. Characteristics related to the history, onset, the biology of the disease, its epidemiology, clinical chart, treatment, prognosis and prevention were analyzed. Cholera is an acute intestinal infection caused by the ingestion of Vibriocholerae, a bacterium that lives in waters and food contaminated by fecal matters, which is transmitted through these elements, representing a permanent risk in several countries. The major risk is observed in communities and overpopulated locations with deprived sanitary conditions; however in a well-educated and well-prepared community having opportune treatment, lethality do not surpass 1%. Clinical manifestations can be mild, moderate or severe. Doxycycline is the elective antibiotic therapy but the most important are those to prevent dehydration. Antibiotics are used only in severe cases. Adequate hygienic education to the population is essential, together with food and drinking water treatment, in addition to an appropriate waste disposal.

Comportamiento de la Influenza A H1N1 entre abril y octubre del 2009, Pinar del Río / Behavior of Influenza-A (H1N1) virus from April to October, 2009, Pinar del Rio

Se realizó una investigación observacional, descriptiva y transversal, y revisaron los documentos estadísticos, encuestas epidemiológicas y los registros de atenciones médicas por influenza A H1N1. El diagnóstico se confirmó mediante el exudado nasofaríngeo, utilizando el método de PCR convencional y en tiempo real en el Instituto Nacional de Medicina Tropical Pedro Kourí. Los municipios más afectados fueron Pinar del Rio (53.4%) y Sandino (24.4%), el 63.8% de los casos fueron autóctonos. Las edades más afectadas fueron de 15 a 65 años, con el 75.9%; no hay diferencias en la distribución por el sexo. Octubre fue el mes con mayor aparición de casos (29.3%), seguido de julio y agosto, a partir de septiembre todos los casos fueron autóctonos. El 65.5 % de los casos ingresó en las primeras 72 horas y no necesitó de cuidados intensivos, el 52.9% de los graves ingresó después de los 3 días, siendo el 72.7% los casos ventilados. Los principales antecedentes fueron el embarazo, los trastornos neurológicos y las enfermedades respiratorias crónicas; el 77.6% no manifestó antecedentes. Todos presentaron fiebre, y la mayoría tos y rinorrea; la disnea se presentó en los casos graves. En la provincia la epidemia se comportó similar al resto del mundo y la adopción de medidas rápidas propició una evolución favorable en la mayoría de los casos atendidos.

An observational, descriptive and cross-sectional research was conducted through the review of statistical documents, epidemiological and medical assistance records of Influenza-A (H1N1). The diagnosis was confirmed by means of nasopharyngeal smear, using conventional and real time C-reactive protein (CRP) at "Pedro Kouri" National Institute. The most affected municipalities were: Pinar del Rio (53.4%) and Sandino (24.4%), with 63.8% of autochthonous cases and ages between 15-65 (75.9%); observing no differences in sex distribution. In October the cases reached a figure of 29.3%, followed by July and August, from September all cases were autochthonous; 65.5% of the cases were admitted before the first 72 hours with no need of intensive care; 52.9% of the severe cases were admitted 3 days after the onset of symptoms (72.7% with artificial ventilation). Pregnancy, neurological disorders and chronic respiratory diseases showed more incidences; 77.6% presented no antecedents. All cases had fever, cough and rhinorrhea; dyspnea was present in severe cases. The epidemics behaved similar to the rest of the world and the adoption of early and rapid measures favored a good progress in the majority of cases.

Inmunopatología de la influenza A H1N1 / Immunology of the Influenza A H1N1 infection

Se realiza una actualización sobra la virología e inmunología en la infección por el virus A H1N1. La primera epidemia del siglo XXI fue declarada por la OMS el 9 de junio de 2009. H1N1 es un nuevo virus de la influenza A con elevada contagiosidad lo que ha influido en la velocidad de propagación de la infección entre los diferentes países y ha propiciado una alta morbimortalidad. La característica de su genoma (ARN), al estar constituido por 8 fragmentos, interviene en la replicación viral defectuosa y en el proceso de flujo y cambio antigénico, con rearreglo genético que causa la aparición de nuevas cepas del virus. La inducción ineficiente de interferón por la célula hospedera, el débil papel de los anticuerpos neutralizantes en la primoinfección, y la liberación de citoquinas proinflamatorias, sumado a las sobreinfecciones bacterianas condicionan la alta morbilidad y mortalidad que se incrementa en determinadas condiciones de comorbilidad de los individuos infectados. Los cambios que ocurren en los antígenos virales impiden el reconocimiento por el sistema inmune., y ahí radica la dificultad para la preparación definitiva de una vacuna. Entender la inmunopatología de la infección, así como divulgar esta información a la comunidad científica, constituye el paso inicial para la toma de decisiones a favor de evitar la propagación de la infección.

An update about the virology and immunology of the Influenza A H1N1 infection is made. The first epidemic of the XXIth century was addresses by WHO on June 9th, 2009. H1N1 is a new virus of the Influenza A, showing increased infection, thereby influencing on the spreading speed of the infection among different countries leading to high morbidity and mortality. The viral genome (RNA), being formed of 8 fragments, works for a defective viral replication and on the process of antigenic flux and change, having a genetic rearrangement causing the appearance of new viral strains. The inefficient induction of interferon, the weak role of neutralizing antibodies in the prime-infection, and the release of pro-inflammatory cytokines, added to the bacterial superimposed infections will condition the high morbidity and mortality that are increased in certain comorbid conditions of the infected individuals. Changes occurring on viral antigens avoid the reconnaissance of the virus by the immune system, then the difficulty to make a proper vaccine. Understanding the immunopathology of this infection, so as the divulgation of this information to the scientific community, are the initial steps for the taking of decisions to favor the avoiding of the infection spreading.

La influenza A (H1N1): estado actual del conocimiento / Influenza A (H1N1) virus: current information

Se revisó la bibliografía actualizada sobre el tema a partir de los principales buscadores, y reuniones internacionales realizadas sobre la pandemia de la influenza A (H1N1). Se tratan los aspectos relacionados con la historia, la aparición de la pandemia, la biología de la enfermedad, la epidemiología, el cuadro clínico, el tratamiento y el pronóstico y la prevención. La gripe A (H1N1) es una pandemia causada por una variante nueva del virus de la Influenza A que ha sufrido cambios antigénicos en la hemaglutinina y la neuraminidasa. Esto hace que la población sea altamente vulnerable a la infección y produce una sobrecarga temporal enorme a los servicios de salud. El virus se trasmite como otros virus Influenza. Su letalidad es similar a la de la influenza estacional, pero puede incrementarse en personas con factores de riesgo y en adultos jóvenes sanos. El asma y el embarazo parecen ser condiciones de base importantes para incrementar la severidad de la infección. Puede existir cierta protección por inmunidad cruzada con cepas que circularon en el pasado. El espectro clínico va desde personas asintomáticas hasta las formas graves que requieren internación en cuidados intensivos, con rápido deterioro hasta llegar a la insuficiencia respiratoria en un plazo de 24 horas. La vacunación durante la pandemia no parece ser suficientemente efectiva. Son necesarios antivirales (oseltamivir y zanamivir), y las medidas preventivas higiénico-sanitarias son muy eficaces.

An updated review using the main search motors and international meetings already celebrated related to Influenza A H1N1 pandemics. Items related to the history, the appearance of the pandemics, the biology of the disease, its epidemiology, clinics, treatment, prognosis and prevention. Grippe A H1N1 is a pandemic caused by a new variant of the Influenza A virus that has suffered antigenic changes in haemaglutinin and neuraminidase. This turns populations more susceptible to this infection and produces a temporary burden on the health services. This virus is transmitted like other influenza viruses. Its lethality is similar to that observed for the seasonal influenza, but may be enhanced in people having risk factors and in healthy young adults. Asthma and pregnancy seem to be basic conditions to increase the severity of the infection. Certain degree of protection may exist, due to cross immunity with ancient strains that circulated in the past times. The clinical spectrum goes from asymptomatic people to the most severe forms requiring intensive care, when a rapid deterioration of the health up to reach a respiratory failure in 24 hours. Vaccination during the epidemics seems to be non effective. Antiviral agents (oseltamivir and zanamivir) are necessary, and the preventive hygiene-sanitary measures are highly effective.

Applied ethics in mental health in Cuba: part I--guiding concepts and values.

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.

Applied ethics in mental health in Cuba: part II--power differentials, dilemmas, resources, and limitations.

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to (a) the interests of clients, (b) their personal interests, and (c) the interests of the state. These conflicts are related to power differentials among (a) clients and professionals, (b) professionals from different disciplines, and (c) professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics.