The Birmingham community pharmacy repeat dispensing project

Report on a pilot project funded by the Dept of Health and involving 350 repeat dispensing patients at 7 community pharmacies and two medical practices. 82% of patients approached were willing to enter a repeat dispensing service and after 6 months 86% liked the system. Concludes that successful repeat dispensing depends on a good infrastructure in both the pharmacy and the medical practice, and requires established inter-professional communication.

Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham elderly thyroid study

Context: Subclinical hypothyroidism (SCH) and cognitive dysfunction are both common in the elderly and have been linked. It is important to determine whether T4 replacement therapy in SCH confers cognitive benefit. Objective: Our objective was to determine whether administration of T4 replacement to achieve biochemical euthyroidism in subjects with SCH improves cognitive function. Design and Setting: We conducted a double-blind placebo-controlled randomized controlled trial in the context of United Kingdom primary care. Patients: Ninety-four subjects aged 65 yr and over (57 females, 37 males) with SCH were recruited from a population of 147 identified by screening. Intervention: T4 or placebo was given at an initial dosage of one tablet of either placebo or 25 µg T4 per day for 12 months. Thyroid function tests were performed at 8-weekly intervals with dosage adjusted in one-tablet increments to achieve TSH within the reference range for subjects in treatment arm. Fifty-two subjects received T4 (31 females, 21 males; mean age 73.5 yr, range 65–94 yr); 42 subjects received placebo (26 females, 16 males; mean age 74.2 yr, 66–84 yr). Main Outcome Measures: Mini-Mental State Examination, Middlesex Elderly Assessment of Mental State (covering orientation, learning, memory, numeracy, perception, attention, and language skills), and Trail-Making A and B were administered. Results: Eighty-two percent and 84% in the T4 group achieved euthyroidism at 6- and 12-month intervals, respectively. Cognitive function scores at baseline and 6 and 12 months were as follows: Mini-Mental State Examination T4 group, 28.26, 28.9, and 28.28, and placebo group, 28.17, 27.82, and 28.25 [not significant (NS)]; Middlesex Elderly Assessment of Mental State T4 group, 11.72, 11.67, and 11.78, and placebo group, 11.21, 11.47, and 11.44 (NS); Trail-Making A T4 group, 45.72, 47.65, and 44.52, and placebo group, 50.29, 49.00, and 46.97 (NS); and Trail-Making B T4 group, 110.57, 106.61, and 96.67, and placebo group, 131.46, 119.13, and 108.38 (NS). Linear mixed-model analysis demonstrated no significant changes in any of the measures of cognitive function over time and no between-group difference in cognitive scores at 6 and 12 months. Conclusions: This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.

Bilingualism and educational achievement:a study of young bilinguals in Birmingham schools and colleges

This study aimed firstly to investigate current patterns of language use amongst young bilinguals in Birmingham and secondly to examine the relationship between this language use and educational achievement. The research then focussed on various practices, customs and attitudes which would favour the attrition or survival of minority languages in the British situation. The data necessary to address this question was provided by a sample of three hundred and seventy-four 16-19 year olds, studying in Birmingham schools and colleges during the period 1987-1990 and drawn from the main linguistic minority communities in Birmingham. The research methods chosen were both quantitative and qualitative. The study found evidence of ethnolinguistic vitality amongst many of the linguistic minority communities in Birmingham: a number of practices and a range of attitudes indicate that linguistic diversity may continue and that a stable diglossic situation may develop in some instances, particularly where demographical and religious factors lead to closeness of association. Where language attrition is occurring it is often because of the move from a less prestigious minority language or dialect to a more prestigious minority language in addition to pressures from English. The educational experience of the sample indicates that literacy and formal language study are of key importance if personal bilingualism is to be experienced as an asset; high levels of oral proficiency in the L1 and L2 do not, on their own, necessarily correlate with positive educational benefit. The intervening variable associated with educational achievement appears to be the formal language learning process and literacy. A number of attitudes and practices, including the very close associations maintained with some of the countries of origin of the families, were seen to aid or hinder first language maintenance and second language acquisition.

The directions taken by young people on leaving compulsory education:a study in two Birmingham schools

The thesis addresses the relative importance of factors affecting working-class school-leavers' post-compulsory education transitions into post-sixteen education, training, employment and unemployment. It focuses on school-leavers choosing to enter the labour market, whether successfully or not and the influences affecting this choice. Methodologically, the longitudinal approach followed young people from before they left school to a period of months after. Discrepancies between young people's intended and actual destinations emphasised the diverse influences on post-sixteen transitions. These influences were investigated through a dynamic multi-method approach, drawing from quantitative and qualitative methodologies providing depth and insight while locating the research within a structural framework, allowing a comparison with local and national trends. Two crucial factors of school and gender affected young people's intended and actual post-sixteen directions. School policy, including treatment of disaffected pupils and recruitment to a large, on-site sixth form, influenced the number of pupils opting to continue their education. Girls were more likely to continue education after the end of compulsory schooling and gave different reasons to boys for doing so. Family and peer groups were influential, helping young people develop a 'horizon for action' incorporating habitus and subjective preferences that specified acceptable post-sixteen directions. These influences operated within the context of the local labour market. Perception of the latter rather than actual conditions informed post-sixteen decisions; however, labour market reality influenced the success of the school-leavers' endeavours. The research found that the economics-based rational choice model of decision-making did not apply to many working class school-leavers. The cohort made pragmatically rational decisions dependent on their 'horizon for action'. based on partial, occasionally inaccurate information. Policy recommendations consider the careers service and structure or school sixth forms as aiding successful transitions from compulsory education into education, employment or training. The maintenance allowance may be ineffectual in tackling its objective of social inclusion.

An assessment of the industry cluster approach as a tool for local economic development:the case of the new media industry in Birmingham

Industry cluster policies are a current trend in local economic development programmes and represent a major shift from traditional approaches. This trend has been coupled by an increasing interest in new media industry as a significant focus for regional development strategies. In England clusters and new media industry have therefore come to be seen as important tools in promoting local and regional economic development. This study aimed to ascertain the success of these policies. In order to achieve the aims of the study, the Birmingham new media industry was chosen for the study. In addition to an extensive review of the literature, semi-structured interviews were conducted with new media firms and Business Support Agencies (BSAs) offering programmes to promote the development of the new media industry cluster. The key findings of the thesis are that the concerns of new media industry when choosing their location do not conform to the industry cluster theory. Moreover, close proximity in geographical location of the industries does not mean there is collaboration and any costs saved as a result of close proximity to similar firms are at present seen as irrelevant because of the type of products they offer. Building trust between firms is the key in developing the new media industry cluster and the BSAs can act as a broker and provide neutral ground to develop it. The key policy recommendations are that new media industry is continually changing and research must continuously track and analyse cluster dynamics in order to be aware of emerging trends and future developments that can positively and negatively affect the cluster. Policy makers need to keep in mind that there is no uniform tool kit to foster the different sectors in cluster development. It is also important for them to be winning support and trust of new media firms since this is key in the success of the cluster. When cluster programs are introduced they must explain their benefits to industries more effectively in order to encourage them to participate in programmes. The general conclusions of the thesis are that clusters are a potentially important tool in local economic development policy and that the new media industry has a considerable growth potential. The kinds of relationships which cluster theory suggests develop between do not, as yet, appear to exist within the new media cluster. There are however, steps that the BSAs can take to encourage their development. Thus, the BSAs need to ensure that they establish an environment that enables growth of the industry.

A sociological analysis of four police consultative committees in Birmingham

Consultation between the police and the community was a recommendation of Lord Scarman in his report into the Brixton riots in 1981. By 1982 the West Midlands Police Authority had established local consultative committees on each police sub-division. This thesis is a study of four Police Consultative Committees in Birmingham, using qualitative methods of attendance at committee meetings and interviews with committee members. The research was carried out between 1990 and 1992 - ten years after formal consultation was established, and aimed to examine the relationship between the micro social processes of the committees and key sociological theoretical concepts. The analysis of the four committees contextualises them within the social and political parameters of urban policing in the late 1980s. Each committee is taken as a case study to highlight the following aspects of consultation:- relations between the police and black communities; membership, representation and accountability; responding to community conflict; crime prevention agencies and networks of social control. The findings are then generalised to the sociological theoretical concepts of hegemony, legitimation, community conflict and social control. The central proposition of this thesis is that, whilst these committees are not fulfilling the role Lord Scarman envisaged for them (of involving local community representatives in policing strategies and policies), they do have important policing and political roles. It is argued that they offer a platform from which senior police officers can engage local people into supporting policing objectives without actually involving them in determining those objectives. Furthermore, such committees have political symbolism in that they enable the government to be seen to be responding to the issues of accountability and relations between the police and black communities following the urban disorders, without actually devolving any statutory powers to the community.

Professions, class and society:solicitors in 19th century Birmingham

The thesis provides an analysis of an occupation in the process of making itself a profession. The solicitors' profession in Birmingham underwent a great many changes during the 19th century against a background of industrialisation and urbanisation. The solicitors' conception of their status and role, in the face of these challenges, had implications for successful strategies of professionalisation. The increased prestige and power of the profession, and especially its elite, are examined in their social context rather than in terms of a technical process, or educational and organisational change. The thesis argues that -the profession's social relationships and broad concerns were significant in establishing solicitors as "professional men". In particular these are related to the profession's efforts to gain control of markets for legal services and increase social status. In the course of achieving these aims a concept of profession and a self-image were articulated by solicitors in order to persuade society and the state of the legitimacy of their claims. The concept of the gentlemanly professional was of critical importance in this instance. The successful creation of a provincial professional "community" by the end of the 19th century rested principally on a social and moral conception of professionalism rather than one which stressed specialised training and knowledge, professional organisations and credentials.

Minority enterprise in the clothing industry: an analysis of Asian jeans manufacturers in Birmingham

This thesis discusses and assesses the resources available to Asian entrepreneurs in the West Midlands' clothing industry and how they are used by these small businessmen in order to address opportunities in the market economy within the constraints imposed. The fashion industry is volatile and is dependent upon flexible firms which can respond quickly to shortrun production schedules. Small firms are best able to respond to this market environment. Production of jeans presents an interesting departure from the mainstream fashion industry. It is traditionally gared towards longrun production schedules where multinational enterprises have artificially diversified the market, promoting the 'right' brand name and have established control of the upper end of the market, whilst imports from Newly Developing Countries have catered for cheap copies at the lower end of the market. In recent years, a fashion element to jeans has emerged, thus opening a market gap for U.K. manufacturers to respond in the same way as for other fashion articles. A large immigrant population, previously serving the now declining factories and foundries of the West Midlands but, through redundancy, no longer a part of this employment sector, has ~5ponded to economic constraints and market opportunities by drawing on ethnic network resources for competitive access to labour, finance and contacts, to attack the emergent market gap. Two models of these Asian entrepreneurs are developed. One being somecne who has professionally and actively tackled the market gap and become established. These entrepreneurs are usually educated and have personal experience in business and were amongst the first to perceive opportunities to enter the industry, actively utilising their ethnicity as a resource upon which to draw for favorable access to cheap, flexible labour and capital. The second model is composed of later entrants to jeans manufacturing. They have less formal education and experience and have been pushed into self-employment by constraints of unemployment. Their ethnicity is passively used as a resource. They are more likely confined to the marginal activity of 'cut make and trim' and have little opportunity to increase profit margins, become estalished or expand.

Business cycles, long waves, and company langevity in Birmingham area metal industries 1780-1980

This doctoral thesis originates from an observational incongruence between the perennial aims and aspirations of economic endeavour and actually recorded outcomes, which frequently seem contrary to those intended and of a recurrent, cyclical type. The research hypothesizes parallel movement between unstable business environments through time, as expressed by periodically fluctuating levels of economic activity, and the precipitation rates of industrial production companies. A major problem arose from the need to provide theoretical and empirical cohesion from the conflicting, partial and fragmented interpretations of several hundred historians and economists, without which the research question would remain unanswerable. An attempt to discover a master cycle, or superimposition theorem, failed, but was replaced by minute analysis of both the concept of cycles and their underlying data-bases. A novel technique of congregational analysis emerged, resulting in an integrated matrix of numerical history. Two centuries of industrial revolution history in England and Wales was then explored and recomposed for the first time in a single account of change, thereby providing a factual basis for the matrix. The accompanying history of the Birmingham area provided the context of research into the failure rates and longevities of firms in the city's staple metal industries. Sample specific results are obtained for company longevities in the Birmingham area. Some novel presentational forms are deployed for results of a postal questionnaire to surviving firms. Practical demonstration of the new index of national economic activity (INEA) in relation to company insolvencies leads to conclusions and suggestions for further applications of research into the tempo of change, substantial Appendices support the thesis and provide a compendium of information covering immediately contiguous domains.

Communities, centres, connections, disconnections:some reflections on the riots in Birmingham

This paper presents key ideas from fieldwork conducted in Birmingham between 2009 and 2011. This work examined identity in 'white' neighbourhoods, and attitudes to politics and understandings of poverty in more mixed ones. This work revealed that many Birmingham residents were concerned about a perceived loss of values, the impact of 'unrespectable' households and individuals in their areas and the apparent disconnect between political representatives and local residents. In the aftermath of the disturbances of August 2011 across England, including in Birmingham, we revisit these themes and examine the implications for understanding disorder in the city of Birmingham.

EEC energy policy and the UK:the Birmingham energy model

This paper examines the implications of the EEC common energy policy for the UK energy sector as represented by a long-term programming model. The model suggests that the UK will be a substantial net exporter of energy in 1985 and will therefore make an important contribution towards the EEC's efforts to meet its import dependency target of 50% or less of gross inland consumption. Furthermore, the UK energy sector could operate within the 1985 EEC energy policy constraints with relatively low extra cost up to the year 2020 (the end of the period covered by the model). The main effect of the constraints would be to bring forward the production of synthetic gas and oil from coal.