Relative importance of rate and place: experiments using pitch scaling techniques with cochlear implants recipients.

Pitch scaling was used to determine the dependence of perceived pitch on rate and place of stimulation in postlingually deafened adult subjects using cochlear implants. For stimulation rates below about 500 pulses per second (pps), perceived pitch is a strong function of both rate and place. In this range, perceived pitch increases logarithmically with stimulation rate, but decreases with distance from the round window. A 2-mm displacement into the cochlea has an effect similar to that of halving the stimulation rate. Place resolution in this context is comparable with the interelectrode spacing (0.75 mm). At rates approaching 1,000 pps, rate has little effect on perceived pitch. An average of bipolar quality judgments showed that periodic pulsatile stimulation is least pleasant when low frequencies are applied to the region closest to the window.

Dementia care needs in an area population: case register data and morbidity survey estimates.

OBJECTIVE: To compare case register data on the frequency and distribution of known dementia cases in a metropolitan area population with expected total numbers computed from a national disability survey. METHOD: Known cases were enumerated by a cross-sectional census of the Camberwell Dementia Register. Expected total numbers were calculated using the Cognitive Disability (CD) Planning Model, based on the OPCS national survey of disability, 1985-86. RESULTS: Cases ascertained by the Dementia Register census comprised one-fifth of expected total prevalence. The proportion of such cases was higher for persons in long-stay care (1 in 3) than for those in private households (1 in 7). According to the CD Planning Model, cases known to specialist agencies were on average no more severely disabled and dependent than those who were unknown. In terms of absolute numbers, the district nursing and home help services appeared to be the most important untapped sources of case detection, but other research indicates that general practice contacts (not included in the planning model) may be at least equally important. CONCLUSIONS: At any given time, a high proportion of dementia cases, whether in long-stay care or in the community, will be outside the purview of specialist services. Primary care agencies are a major potential source, and a systematic health screening of persons aged over 75 years could be used to realize this potential.

Norfolk general practice: a comparison of rural and urban doctors.

A postal questionnaire was sent to all Norfolk practitioners, allowing a comparison to be made between rural general practice and urban practice in Norwich and Great Yarmouth. However, when Norfolk town and country doctors were compared, little difference was found in their personal or practice characteristics. In respect of their workload rural doctors, as expected, carried out more procedures overall but, somewhat surprisingly, did not make more home visits. Both sets of doctors had similar views on their present and future role in general practice.When Norfolk doctors collectively were compared with general practitioners nationally their service appeared to be of a high standard. The only uncertainty surrounded the effects of the greater clustering of Norfolk surgeries, together with the levels of home visiting and their attendant effects on patient accessibility.

Rural health care: a British success or a tale of unmet need?

Discussion over health needs and health care in the U.K. has mainly centered on the urban area. The countryside has not been included in this debate because it is assumed that rural people are healthier than their urban counterparts and that health and social services are more effective. This paper questions these two premises and shows higher than expected levels of illness in the rural area and the health services to be largely dependent on general practice which, like all rural services, is becoming increasingly centralised and inaccessible. What is needed, it is argued, is the construction of a case for more localised care. Not that this should necessarily lead to a singularly rural type of health service, rather that patterns of provision should be adapted to local needs wherever they are situated.

Role of branch surgeries in a rural area.

Surveys of general practitioners and rural residents were conducted in Norfolk to establish the characteristics of branch surgeries in the district and the patients who use them. The branch surgeries tend to serve an unrepresentative section of patients, predominantly those disadvantaged both in health and personal mobility-those from manual social classes, the elderly and those without cars. While doctors and patients were agreed that lower standards of care are provided in most branch surgeries compared with main surgeries, the evidence suggests that branch surgeries nevertheless meet a social need.

Audiometric zero for air conduction using manual audiometry.

Thresholds of hearing of 76 subjects in the age range 18-24 years were measured using manual audiometers. Particular attention was paid to the otological selection of subjects. In spite of precautions the testers introduce some variation in results, and it is suggested that tester variation might account for differences between various manual audiometry studies and automatic audiometry studies. When tester variation is included there is no significant difference between results of this manual study and that undertaken with automatic audiometers by Robinson, Shipton, and Hinchcliffe, except that our average threshold is higher at 0.5 kHz. We support their main recommendation for adjustment of standards at 0.5 and 6 kHz.

Hearing acuity in young people exposed to pop music and other noise.

An investigation by questionary, otological examination, and audiometry has been carried out on 505 students in higher education. Statistically significant hearing losses were found in the group that admitted frequent attendance at pop-music entertainment compared with a control group. Losses associated with vacation employment in loud noise or with gunfire exposure were also identified. Thses losses were unrecognised before investigation and indicate the need for preventive action.