• Acute aldosterone antagonism improves cardiac vagal control in humans.

      Fletcher, Janine; Buch, Ashesh N.; Routledge, Helen C.; Chowdhary, Saqib; Coote, John H.; Townend, Jonathan N. (Elsevier BV, 2004)
      OBJECTIVES: We have examined the acute effects (<45 min) of aldosterone antagonism on heart rate variability and baroreflex sensitivity, markers of cardiac vagal control, in 13 healthy subjects. BACKGROUND: Evidence for the beneficial effects of aldosterone antagonists comes from studies showing increased survival rates following their addition to standard heart failure therapy. Many mechanisms have been suggested for this action, including effects upon the autonomic nervous system. METHODS: Heart rate variability and baroreflex sensitivity were examined 30 min following the administration of potassium canrenoate (intravenous) (aldosterone antagonist) or saline (control). RESULTS: Active treatment reduced resting heart rate (-6 +/- 1 beats/min [mean +/- standard error mean]) compared to control (0 +/- 1 beat/min) (p < 0.001) and increased measures of high frequency (HF) heart rate variability. Root mean square of successive RR interval differences increased by 21 +/- 5 ms versus -6 +/- 5 ms control (p < 0.001); HF power increased by 1,369 +/- 674 ms(2)with aldosterone antagonism compared to -255 +/- 431 ms(2) following saline infusion (p < 0.01). Baroreflex sensitivity (alpha-HF) was increased after active treatment (+4 +/- 2 ms/mm Hg vs. 0 +/- 1 ms/mm Hg control [p < 0.05]). No changes in plasma potassium levels were observed. CONCLUSIONS: These results provide evidence that aldosterone antagonists acutely improve cardiac vagal control, irrespective of any diuretic effects, and may in part explain their beneficial effects in treatment of heart failure.
    • Acute rise of circulating vascular endothelial growth factor-A in patients with coronary artery disease following cardiothoracic surgery.

      Cotton, James M.; Mathur, A.; Hong, Ying; Brown, Angie S.; Martin, John F.; Erusalimsky, Jorge D.
      AIMS: Vascular endothelial growth factor-A (VEGF-A) is an angiogenic and vasoprotective molecule whose expression is modulated by hypoxia and inflammatory mediators. Here we have tested the hypothesis that plasma levels of VEGF-A are influenced by pre-existing coronary artery disease and by changes in circulating interleukin-6 (IL-6). METHODS AND RESULTS: Plasma VEGF-A and IL-6 were measured prior to and at various time intervals following surgery in individuals with angiographically normal coronary arteries requiring cardiac valve replacement (N group) and in patients with coronary artery disease and stable angina undergoing coronary artery bypass grafting (CAD group). Baseline VEGF-A levels were not significantly different in CAD (22.3+/-2.6 pg x ml(-1)) compared to the N group (14.9+/-2.9 pg x ml(-1)). Following cardiac surgery there was a significant rise of VEGF-A in CAD (P<0.0005 vs baseline), but not in the N group, reaching a maximum (approximately 2 fold increase) after 24 h. Surgery caused a rapid increase of plasma IL-6 in both groups, but the rise was significantly larger in CAD patients (P<0.0005 vs N) where it preceded the increase in VEGF-A. Furthermore, in patients with CAD there was a significant correlation between the change in VEGF-A and the change in IL-6 (P<0.04). CONCLUSION: These findings demonstrate that in patients with coronary artery disease cardiothoracic surgery leads to an acute rise in VEGF-A. We suggest that this rise may result from an interaction between the pre-existing atheromatous process and a systemic increase of inflammatory mediators.
    • Angiogenesis in chronically ischaemic human heart following percutaneous myocardial revascularisation.

      Cotton, James M.; Thomas, M.R.; Dunmore, Simon J.; Salisbury, J.; Shah, Ajay M.; Brindle, N.P.J. (BMJ Journals, 2002)
      Patients with intractable angina and severe diffuse coronary artery disease not amenable to conventional revascularisation therapy have relatively few treatment options. A number of studies suggest myocardial laser revascularisation is of clinical benefit in such patients.1, 2 Percutaneous myocardial revascularisation (PMR) involves the use of an intravascular catheter, positioned within the left ventricular cavity under fluoroscopic guidance, to deliver controlled bursts of holmium:YAG laser energy. PMR results in the formation of small channels (~1.75 mm diameter) that extend from the endocardial surface partly into the myocardial wall. Many uncontrolled studies suggest that PMR provides symptomatic relief, although the first randomised controlled trial demonstrated no benefit over a sham procedure.3 It has been suggested that PMR induces angiogenesis, although many other mechanisms of action have been suggested. To determine whether PMR has any effects on angiogenesis in the human ischaemic myocardium we have undertaken a detailed histological and immunohistochemical examination of the hearts of two patients who died eight weeks and 52 weeks after apparently symptomatically successful PMR therapy. In this first detailed study of human myocardium subjected to percutaneous myocardial laser revascularisation, we report evidence of sustained myocardial neovascularisation in treated areas and of the presence of vascular endothelial growth factor (VEGF). Unexpectedly, most of the neovessels are abnormal and immature, lacking a smooth muscle coat. Furthermore, neovessels are largely confined to scar tissue. Both the above factors are likely to limit the extent to which angiogenesis following PMR could improve perfusion. In a broader context, our findings that, once formed, immature and abnormal neovessels are sustained long term in human myocardium, may be relevant to the general design of strategies for therapeutic angiogenesis in patients—for example, the direct application of angiogenic factors (or genes).
    • Approaching consensus in clinical competence assessment. Third round of a Delphi study of academics' and clinicians' perceptions of physiotherapy undergraduates

      Cross, Vinette (Elsevier, 2001)
      Quality measurement in healthcare and higher education has highlighted the need for a systematic approach to the development of instruments to assess the clinical performance of undergraduates. This paper describes the third and final round of a Delphi study to investigate the degree of national consensus on desirable attributes for physiotherapy undergraduates on clinical placement. This third round investigates how the two panels – clinicians and academics – would recognise and interpret what they observed in students' behaviour in terms of the desirable attributes identified in preceding rounds. Eighty-nine observable behaviours were identified in relation to 12 desirable attributes associated with clinical competence. All but six behaviours were identified by both clinicians and academics, but there were discrepancies in the frequency of responses that suggested differing perceptions between the two panels of the importance of some attributes. Application of the binomial test (SPSS) indicated that the identified behaviours were a valid representation of competence as defined by the CSP/CPSM undergraduate curriculum framework. It was concluded that the behaviours provided a starting point for development of a clinical assessment instrument that could optimise the validity and reliability of clinical assessment decisions.
    • The attitudes of student nurses towards obese patients: A questionnaire study exploring the association between perceived causal factors and advice giving.

      Nicholls, Wendy; Pilsbury, Linda; Blake, Marcia; Devonport, Tracey J (Elsevier, 2015-11-14)
      Nurses acting in primary care roles are central in addressing obesity as a public health priority. Nurses with a lower Body Mass Index have been shown to have negative attitudes towards obesity. Additionally, where the patient is perceived as being responsible for their excess weight, a negative attitude may also be held. The extent to which negative attitudes may influence the advice provided by nurses to obese patients is unknown.
    • Birthweight - is it linked to minor illness in adulthood?

      Bellingham-Young, Denise; Adamson-Macedo, Elvidina N. (Society of Integrated Sciences, 2000)
      OBJECTIVE: The Barker's hypothesis states that poor nutrition in vitro is linked to low birthweight and major illness, in particular cardiovascular disease, in later life. Reported here is an investigation to establish links with birthweight and minor illness. METHODS: 78 participants whose birthweight ranged from 1.93 kg to 4.88 kg with a mean to 3.31 kg completed a symptom checklist. RESULTS: Analysis of variance indicates that those with a higher birthweight experience less minor illness. Regression analysis indicates that birthweight is significantly predictive of levels of some minor illnesses. CONCLUSION: This investigation adds a new dimension to Barker's hypothesis and shows that early environment can also affect levels of minor illness. It is suggested that susceptibility to minor illness may be explained by coactions between structure, function and environment prior to birth.
    • Breaking traditions: sexual health and ethnicity in nursing research: a literature review.

      Serrant-Green, Laura (Wiley InterScience, 2005)
      AIM: The aim of this paper is to explore some reasons for the lack of focus on ethnicity and sexual health in nursing research, and suggest ways to advance the nursing evidence-base required for practice development. BACKGROUND: The United Kingdom National Strategy for Sexual Health and human immunodeficiency virus published in July 2001 highlighted the continued rise in sexual ill health amongst minority ethnic groups. In order to improve sexual health, research evidence is needed explain why particular ethnic groups appear to be at greater risk of sexual ill health. The Strategy identified nurses as key to bringing about improvements in sexual health. Nursing research includes many studies exploring links between ethnicity and health. However, with the exception of extensive work on human immunodeficiency virus/acquired immunodeficiency syndrome as a specific disease, nursing research into ethnicity has not systematically included sexual health. METHODS: Literature searches were conducted using the BIDS database, World Wide Web and United Kingdom Department of health website between June 2000 and August 2003. Papers written in English incorporating the keywords 'sexual health', 'sexually transmitted infection' and 'health and ethnicity' in the title or abstract were selected for review. FINDINGS: Nursing research into the association between sexual health and ethnicity is rare. It has been hampered by a variety of political and social constraints concerning the nature of sexual health practice in nursing, researching sexual health, and researching ethnicity and health. The result is a dearth of research evidence to support the development of sexual health practice and the education of healthcare professionals to underpin care of minority ethnic clients. CONCLUSIONS: Barriers to researching ethnicity and sexual health by nurses must be addressed through nursing education and practice. Without this, a detailed evidence base will fail to materialize and healthcare practices to implement the priorities to improve sexual health in minority ethnic communities will remain undeveloped.
    • British English translation of the Food Craving Inventory (FCI-UK).

      Nicholls, Wendy; Hulbert-Williams, Lee (Elsevier, 2013-08)
      There is evidence for cultural variation in the foods that may be craved. We have designed and tested, in a sample of 234 participants, a UK-specific version of the Food Craving Inventory. A four-factor structure comprising of sweet foods, fast foods, high fat, and complex carbohydrates was extracted. The final scale was analogous with the original US scale, and shared similar associations with external eating and dietary restraint, although no association was found with BMI. The measure has potential to contribute to the development of theoretical understanding of food craving, and to measuring outcomes in intervention studies and clinical samples.
    • Buddy system for nursing students: two practice focused approaches to peer support

      Moran, Wendy; Swindlehurst, Matt; Wainwright, Claire; Bucknor, Jenny; Welyczko, Adrian; Hamilton, Lisa; Southan, Lorna (University of Wolverhampton, 2003)
    • "Burt-on-line: incorporating videoconferencing into the School of Health e-family of technologies

      Wildsmith, Peter A (University of Wolverhampton, 2002)
      Communication in nursing is, perhaps, the most important tool of the professional practitioner. During training one learns the principles of effective communication and its import to patient care. Likewise, in education communication is the principal means by which one person may bring about change in others. The complexities of communicating become apparent both when addressing distressed patients or inquisitive and challenging students. The author’s recent past experience in nurse education, utilising the video camera as an adjunct to teaching and learning and also assessing student performance, became the backcloth to this project and the development of the use of videoconferencing in line with the uptake of other contemporary e-technologies. It is worth noting here that videoconferencing equipment already existed within the University but was not being used regularly. Deployment of equipment took place to establish an active videoconferencing studio at the Burton Centre of the School of Health. The aim of the project is that the School centre at Burton upon Trent will develop effective use of videoconferencing [vc] for the enhancement of learning and teaching, for students and staff alike. This would then offer the opportunity for effective distance dialogue, initially by linking Burton Centre and Boundary House [Walsall Campus] where specific facilities are installed. The success of the project would then permit exploration of further links with other School sites and assist in bridging with NHS Trust hospitals and associated external agencies. The project and its title, suggesting inclusion within the family of e- technologies, is ‘Burt-on-line’ and comes from a development of the original idea mooted by Elaine Ballard [PL and Project Manager] and Peter Wildsmith [ SL and Project Leader].
    • Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation

      Green, Julie; Jester, Rebecca; McKinley, Robert; Pooler, Alison; Queen's Nurse, Royal College of Nursing, Professional Nursing Committee member, Royal College of Nursing, District Nurse, Forum Chair and member of the Association of District Nurse Educators: Director of Postgraduate Studies and Senior Lecturer, Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG; Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY; Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY; Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG (Mark Allen Publishing, 2018-03-02)
      This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.
    • Clinical specialisms: patient empowerment or professional control?

      Christie, Alison; Cross, Vinette (Mark Allen Publishing, 2003)
      This study surveyed physiotherapy undergraduates’ perceptions of the control ethos of physiotherapeutic specialisms, and investigated whether they preferred a client-centred or a professional-powered model of working.
    • Collaborative working in health and social care: a review of the literature

      Stepney, Paul M.; Callwood, Ingrid (University of Wolverhampton, 2006)
      The move towards collaborative working in Health and Social Care can be situated within a wider policy shift associated with de-institutionalisation and de-segregation (Payne, 1995). The change from institutional to community-based care (Barr et al, 1999; Sibbald, 2000) meant that the demarcations and hierarchical relations between professions were neither sustainable not appropriate. New ways of working that crossed professional boundaries had to be created, in order to allow a more flexible approach to care delivery (Malin et al, 2002). Collaboration in health and social care is a relatively new field of study, with the first major studies being undertaken in the 1980s (Roy, 2001). The term collaboration has hitherto lacked a clear definition and has been used synonymously with terms such as co-operation, co-ordination, participation and integration. Since the implementation of the 1990 NHS and Community Care Act (Department of Health, 1990), the concept has featured prominently in government policy documents to promote joint working, partnership and the creation of a ‘seamless service’ between health and social care (Maxwell, 1998; Payne, 1995). More recently, the term ‘communities of practice’ (CoPs) has permeated professional agendas (Lave and Wenger, 1991; Anning 2001). At its simplest the concept of collaboration infers that people from different professional and academic backgrounds form a working relationship for the purpose of enhanced service provision. However, the exact nature of the partnership is likely to be contested, whilst fully integrated ‘joined-up’ collaborative practice has so far proved elusive.
    • Comparing the importance of clinical competence criteria across specialties: impact on undergraduate assessment

      Cross, Vinette; Hicks, Carolyn; Barwell, Fred (Elsevier, 2001)
      Quality measurement in healthcare and higher education indicates the need for a systematic approach to developing undergraduate clinical competence assessment. Validity and reliability may be undermined by differences in assessors' interpretation of what is important. Differing contexts of undergraduates' clinical experience could result in assessors' ratings of activities being deemed less important, omitted or rendered meaningless. This study investigated the level of agreement across and within five clinical specialties in physiotherapy on the relative importance of 89 activities associated with clinical competence. One-way analysis of variance for each activity revealed 12 items differentially rated (p values = 0.05, 0.01 and 0.001). Kendall's coefficient of concordance demonstrated within-group agreement (p = < 0.000). Factor analysis of items upon which there was maximum agreement across specialties, combined with split half reliability analysis (Cronbach's alpha) resulted in eight reliable factors. These included task-specific and generic transferable skills. It was concluded that the factors provided a basis for discussion about clinicians' and academics' contributions to assessment, and a starting point for development of a clinical assessment instrument that could optimise the validity and reliability of clinical assessment decisions.
    • Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty.

      Shah, Peter; Lee, Graham A.; Kirwan, James K.; Bunce, Catey; Bloom, Philip A.; Ficker, Linda A.; Khaw, Peng T. (Elsevier Science Direct, 2001)
      OBJECTIVE: This study analyzes the results of intraocular pressure (IOP) reduction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty. DESIGN: Retrospective noncomparative, interventional case series. PARTICIPANTS: Twenty-eight eyes in 28 patients attending the Moorfields Eye Hospital. INTERVENTION: Cyclodiode (40 applications x 1.5 W x 1.5 seconds over 270-300 degrees ) was used to control the IOP in refractory glaucoma after penetrating keratoplasty. MAIN OUTCOME MEASURES: Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment. RESULTS: Cyclodiode resulted in a reduction of IOP from a median of 33 mmHg (interquartile range [28, 40.5]) to a median of 15 mmHg (interquartile range [12, 20.5]). Most patients had a significant lowering in IOP with a median reduction of 16 mmHg (interquartile range [12, 25]; P < 0.0001). IOPs of 6 to 21 mmHg were achieved in 22 patients (79%). Sixteen patients (57%) required more than one treatment with cyclodiode to control the IOP, with three patients (11%) requiring three treatments and two patients (7%) requiring four treatments. Visual acuity improved (> two Snellen lines of acuity) in three patients (11%) and remained the same (+/- one Snellen line) in 17 patients (61%). The mean number of antiglaucoma medications before cycloablation was 2.6 and was 1.8 after treatment (P < 0.001). Of the 19 patients (68%) with originally clear grafts, three grafts (16%) developed opacification. One patient (4%), with a history of nanophthalmos and recurrent uveal effusion, had delayed hypotony (IOP < 6 mmHg) occurring 46 months after the diode treatment. All patients had at least 6 months follow-up. CONCLUSIONS: These patients have often undergone multiple previous complicated ocular interventions and are often not suitable for filtration surgery. Reduction of IOP with maintenance of visual acuity and a good safety profile was achieved in most patients in this study but may require multiple treatments. We propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty.
    • Defining expertise in cardiorespiratory physiotherapy

      Roskell, Carolyn; Cross, Vinette (2001)
      This study attempted to define expertise in cardiorespiratory physiotherapy to inform future development of the speciality. A Delphi technique was used to elicit clinicians’ perceptions of expert cardiorespiratory practice. There was good consensus within and between groups on category selection, which provided a framework for exploration of tacit skills under categories supplied by respondents.
    • Detection of secretory immunoglobulin A (SIgA) in saliva of ventilated and non-ventilated preterm neonates.

      Hayes, Julie; Adamson-Macedo, Elvidina N.; Perera, Shantha; Anderson, Janet (National Library of Medicine and National Institutes of Health, 1999)
      The very young preterm neonate has multiple immune deficiencies which may increase his or her vulnerability to infection. Secretory Immunoglobulin A (SIgA) plays an important role in the protection of epithelial surfaces exposed to the external environment; nevertheless controversy exists with regards to the ontogeny of SIgA in newborns and especially the preterm neonate. The objective was to investigate if SIgA could be detected in the saliva of very/extremely low birthweight neonates (V/ELBW). A total of 707 samples which were collected twice daily (morning and afternoon) for three consecutive days were obtained from sixty-eight preterm neonates (mean gestational age 28 weeks; conceptional age ranged from 25-35 weeks). A repeated measures design was used. Total concentration of SIgA was determined from unstimulated saliva by an Enzyme Linked Immunosorbant Assay technique. Results indicated that SIgA was detectable in the early postnatal period in the saliva of both ventilated preterms who were receiving intravenous total parenteral nutrition (TPN) and non-ventilated preterms. A 3-way repeated measures Analysis of Variance (ANOVA) showed no significant effect from 'before' and 'after' samples during a period of spontaneous activity, time and day of sampling. A significant effect of mode of nutrition was found; neonates who were receiving expressed breast milk had significantly higher concentrations of SIgA than those infants receiving TPN (df=3, F=14.27, p<0.0001). These results have implications for the care of the preterm neonate in intensive care.
    • Developing Culturally Sensitive Skills in Health and Social Care with a Focus on Conducting Research with African Caribbean Communities in England

      Higginbottom, Gina Marie Awoko; Serrant-Green, Laura (Nova Southeastern University, 2005)
      Researchers may not feel equipped to conduct qualitative research with ethnic minority communities in England because they may lack of culturally sensitive research skills. The aim of this paper is to explore how researchers might integrate culturally sensitive research skills into their work. This paper draws on our own experiences of conducting research with African Caribbean communities in England, and from workshops we facilitated with researchers and community representatives. The purpose of the workshops was to establish the most pertinent issues in conducting research with ethnic minority communities in England. We gathered data from the participants and created themes based on the discussions: establishing the need for an inclusive approach to research, issues around recruitment, respecting cultural norms, and dealing with disclosure
    • Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.

      Kirwan, James F.; Shah, Peter; Khaw, Peng T. (Elsevier Science Direct, 2002)
      PURPOSE: To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, complications. RESULTS: Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications. CONCLUSIONS: With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.
    • Early prediction and psycho-immunologic mediation of minor illness in adulthood.

      Bellingham-Young, Denise; Adamson-Macedo, Elvidina N. (National Library of Medicine and National Institutes of Health, 2002)
      The Barker Hypothesis suggests that an unfavourable uterine environment can have the effect of programming the body for disease later in life. Research indicates a bidirectional relationship between thought and biochemical reactions, that may be influenced by early programming. Reports suggest that 25% of variance in birthweight is a result of foetal environment and that the health and cognitive deficits do not just affect those with an officially low birthweight. OBJECTIVE: This study investigates the influence of birthweight on cognition and minor illness in adults. METHODS: This is a retrospective, cross sectional design with an opportunity sample of 75 adults. Participants whose birthweight ranged from 2.5 kg to 4.88 kg, completed a symptom check list and general self-efficacy scale, reporting on the previous month. RESULTS: Analysis of variance indicates that those with higher birthweight have fewer minor illness symptom days and higher general self-efficacy. Regression analysis indicates that birthweight is significantly predictive of levels of minor illness and general self-efficacy. CONCLUSION: From the findings of this and previous studies, it is possible to infer vertical coactions between foetal environment and immuno competence. It is suggested that birthweight is an early predictor of levels of a cognitive mediator and minor illness. Data were applied to an equilibrium model to represent the relationship in terms of Gottlieb's concept of horizontal and vertical coactions.