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Reading Test 1 – Part A Time allowed: 15 minutes

• Complete the following summary using the information in the four texts provided. • You do not need to read each text from beginning to end to complete the task. You should scan the texts to find the information you need. • Gaps may require 1, 2 or 3 words. • You should write your answers next to the appropriate number in the right-hand column. • Please use correct spelling in your responses.

TEXT 1 The Global Burden of Dementia An expert group, working for Alzheimer’s Disease International, recently estimated that 24.2 million people live with dementia worldwide (based upon systematic review of prevalence data and expert consensus), with 4.6 million new cases annually (similar to the annual global incidence of non-fatal stroke. •

Most people with dementia live in Low and Middle Income Countries - 60% in 2001 rising to 71% by 2040.

•

Numbers will double every twenty years to over 80 million by 2040.

•

Increases to 2040 will be much sharper in developing (300%) than developed regions (100%).

•

Growth in Latin America will exceed that in any other world region.

Well designed epidemiological research can generate awareness, inform policy, and encourage service development. However, such evidence is lacking in many world regions, and patchy in others, with few studies and widely varying estimates. There is a particular lack of published epidemiological studies in Latin America with two descriptive studies only, from Brazil and Colombia.

TEXT 2 Some Little Known Facts about Dementia •

A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an average of four years when compared to monolingual patients (at 75.5 years and 71.4 years old, respectively).

•

Adult daycare centres provide specialized care for dementia patients, including supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers.

TEXT 3 The Effect of Aging World Populations on Healthcare Demographic ageing proceeds apace in all world regions, more rapidly than at first anticipated. The proportion of older people increases as mortality falls and life expectancy increases. Population growth slows as fertility declines to replacement levels. Latin America, China and India are currently experiencing unprecedentedly rapid demographic ageing. In the health transition accompanying demographic ageing, non-communicable diseases (NCD) assume a progressively greater significance in low and middle-income countries. NCDs are already the leading cause of death in all world regions apart from sub-Saharan Africa. Of the 35 million deaths in 2005 from NCDs, 80% will have been in low and middle-income countries. This is partly because most of the world's older people live in these regions - 60% now rising to 80% by 2050. However, changing patterns of risk exposure also contribute. Latin America exemplifies the third stage of health transition. As life expectancy improves, and high fat diets, cigarette smoking and sedentary lifestyles become more common, so NCDs have maximum public health salience - more so than in stage 2 regions (China and India) where risk exposure is not yet so elevated, and in stage 4 regions (Europe) where public health measures have reduced exposure levels. The INTERHEART cross-national case-control study suggests that risk factors for myocardial infarction operate equivalently in all world regions, including Latin America and China.

TEXT 4 Agitation in Dementia Patients Agitation often accompanies dementia and often precedes the diagnosis of common age-related disorders of cognition such as Alzheimer's disease (AD). More than 80% of people who develop AD eventually become agitated or aggressive. Evaluation It is important to rule out infection and other environmental causes of agitation, such as disease or other bodily discomfort, before initiating any intervention. If no such explanation is found, it is important to support caregivers and educate them about simple strategies such as distraction that may delay the transfer to institutional care (which is often triggered by the onset of agitation). Treatment There is no FDA-approved treatment for agitation in dementia. Medical treatment may begin with a cholinesterase inhibitor, which appears safer than other alternatives although evidence for its efficacy is mixed. If this does not improve the symptoms, atypical antipsychotics may offer an alternative, although they are effective against agitation only in the short-term while posing a well-documented risk of cerebrovascular events (e.g. stroke). Other possible interventions, such as traditional antipsychotics or antidepressants, are less well studied for this condition.

Summary Task Summary

Answers

Populations all over the world are aging due to increased (1) … and lower birth rates. This shift in

1.

population structure means (2) …. . are now relatively more significant in developing countries, and they are

2.

already the leading cause of death in all regions aside from (3) …. . One such non communicable

3.

disease is (4) … , and more than half of all sufferers 4.

live in developing countries.

An expert panel recently commissioned by (5) … to 5. review

worldwide

prevalence

data

found

that

approximately (6) … people suffer from dementia

6.

globally, and a further (7) … patients are diagnosed with the disease every year, making dementia

7.

roughly as common globally as (8) … . (9) … per cent of dementia sufferers in 2001 lived in

8.

low and middle income countries, and growth is expected to (10) … every 20 years, with the highest

9.

rate of growth occurring in (11) ... , where there is a particularly

scarce

amount

of

epidemiological

10.

research. 11.

Summary

Answers

60% of the world’s older people live in low to middle 12. income countries, and this will increase to (12) … by 13. (13) …. . Another contributing factor is changing 14. patterns of (14) … . Countries in the third stage of the (15) … , categorized by higher life expectancy, 15. high fat diets, smoking and (16) …. , are more at risk 16. than the less developed Stage 2 countries, and 17. Stage 4 countries, where (17) … have mitigated risk 18.

exposure.

These changing demographics will place new strains 19. on the healthcare system, and many people suffering

20.

from dementia will require care from family members. In higher income countries, carers are able to enlist

21.

the help of (18) …. , who provide (19) … , recreation 22. and meals for dementia sufferers.

23.

Many caregivers finally transfer their family members to (20) …. when their relatives become aggressive and

(21)

…

.

Doctors

should

first

(22)…

24. 25.

environmental causes, and if none are found, (23)… 26. caregivers about useful techniques like (24)… to 27. delay transfer. Interestingly, a (25) … study found that the age of dementia (26)… was delayed by (27)… in people who speak two languages.

TOTAL SCORE:

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Reading Test 1 - Part B Time allowed: 60 minutes There are two reading passages in this test. After each passage you will find a number of questions or unfinished statements about the passage, each with four suggested answers or ways of finishing. You must choose the one which you think fits best, i.e. the best answer. For each question, 1-20, indicate on your answer sheet the letter A, B, C or D against the number of the question. Answer all questions. Marks will not be deducted for incorrect answers.

READING PASSAGE A

Swine Flu Found in Birds Paragraph 1

Last week the H1N1 virus was found in turkeys on farms in Chile. The UN now says poultry farms elsewhere in the world could also become infected. Scientists are worried that the virus could theoretically mix with more dangerous strains. It has previously spread from humans to pigs. However, swine flu remains no more severe than seasonal flu. Paragraph 2

Chilean authorities first reported the incident last week. Two poultry farms are affected near the seaport of Valparaiso. Juan Lubroth, interim chief veterinary officer of the UN Food and Agriculture Organization (FAO), said: "Once the sick birds have recovered, safe production and processing can 10 continue. They do not pose a threat to the food chain." Paragraph 3

Chilean authorities have established a temporary quarantine and have decided to allow the infected birds to recover rather than culling them. It is thought the incident represents a "spill-over" from infected farm workers to turkeys. Canada, Argentina and Australia have previously reported spread of the H1N1 swine flu virus from farm workers to pigs. Paragraph 4

The emergence of a more dangerous strain of flu remains a theoretical risk. Different strains of virus can mix together in a process called genetic reassortment or recombination. So far there have been no cases of H5N1 bird flu in flocks in Chile. However, Dr Lubroth said: "In Southeast Asia there is a lot of the (H5N1) virus circulating in 20 poultry. "The introduction of H1N1 in these populations would be of greater concern." Paragraph 5

Colin Butter from the UK's Institute of Animal Health agrees. "We hope it is a rare event and we must monitor closely what happens next," he told BBC News. "However, it is not just about the H5N1 strain. Any further spread of the H1N1 virus between birds, or from birds to humans would not be good. "It might make the virus harder to control, because it would be more likely to change." Paragraph 6

William Karesh, vice president of the Wildlife Conservation Society, who studies the spread of animal diseases, says he is not surprised by what has happened. 30 "The location is surprising, but it could be that Chile has a better surveillance system. "However, the only constant is that the situation keeps changing." Paragraph 7

The United States has counted 522 fatalities through Thursday, and nearly 1,800 people had died worldwide through August 13, U.S. and global health officials said. In terms of mortality rate, which considers flu deaths in terms of a nation's population, Brazil ranks seventh, and the United States is 13th, the Brazilian Ministry of Health said in a news release Wednesday.

Paragraph 8

Argentina, which has reported 386 deaths attributed to H1N1 as of August 13, ranks first per capita, the Brazilian health officials said, and Mexico, where the flu outbreak was discovered in April, ranks 14th per capita. 40 Brazil, Argentina, Chile, Mexico and the United States have the most total cases globally, according to the World Health Organization. Paragraph 9

The Brazilian Ministry of Health said there have been 6,100 cases of flu in the nation, with 5,206 cases (85.3 percent) confirmed as H1N1, also known as swine flu. The state of Sao Paulo had 223 deaths through Wednesday, the largest number in the country. In addition, 480 pregnant women have been confirmed with H1N1, of whom 58 died. Swine flu has been shown to hit young people and pregnant women particularly hard. Paragraph 10

Many schools in Sao Paulo have delayed the start of the second semester for a couple of weeks, and students will have to attend classes on weekends to catch up. Schools also have suspended extracurricular activities such as soccer, volleyball and chess to try to 50 curtail spread of the disease. Paragraph 11

Flu traditionally has its peak during the winter months, and South America, where it is winter, has had a large number of cases recently. The World Health Organization said this week that the United States and other heavily populated Northern Hemisphere countries need to brace for a second wave of H1N1 as their winter approaches. Paragraph 12

Officials at the Centres for Disease Control and Prevention and other U.S. health agencies have been preparing and said this week that up to half of the nation's population may contract the disease and 90,000 could die from it. Seasonal flu typically kills about 64,000 Americans each year. Paragraph 13

A vaccine against H1N1 is being tested but is not expected to be available until at least 60 mid-October and will probably require two shots at least one week apart, health officials have said. Since it typically takes a couple of weeks for a person's immunity to build up after the vaccine, most Americans would not be protected until sometime in November. The World Health Organization in June declared a Level 6 worldwide pandemic, the organization's highest classification. CNN News

QUESTIONS

Swine Flu Found in Birds 1.

Scientists are worried that the virus could potentially spread… a.) …from pigs to humans b.) …to chicken and turkey farms elsewhere c.) …to other types of animals d.) …to the seaport of Valparaiso

2.

What does Dr. Lubroth recommend should be done with the sick birds? a.) b.) c.) d.)

3.

What is the meaning of the “spill-over” effect mentioned in the passage? a.) b.) c.) d.)

4.

The virus has spread from Chile to Argentina. The virus has spread from factory workers to birds. Turkey blood has been spilled during the production process. Turkeys have become infected by eating spilled contaminated pig food.

Which possibility is Dr. Lubroth most concerned about? a.) b.) c.) d.)

5.

They should be processed immediately. They should be killed. They should be allowed to recover. They should be given Tamiflu.

H5N1 virus spreading to Chile H591 virus spreading to Australia H191 virus spreading to Asia H191 virus spreading to Canada

Which statement best describes the opinion of the representative from the Institute of Animal Health? a.) He doesnʼt want the virus to spread further because it could lead to genetic reassortment. b.) He thinks H5N1 is no longer important but he is worried about H1N1. c.) He hopes that BBC News will pay more attention to closely monitoring the virus. d.) Birds and humans should be under more control otherwise the virus may change.

6.

Which statement best describes the opinion of the Vice President of the Wildlife Conservation Society? a.) b.) c.) d.)

He is not surprised that not enough people are studying the spread of animal diseases. He is not surprised that swine flu has been reported in birds in Chile. He is surprised that the situation is constantly changing. He is surprised that swine flu has been reported in birds in Chile, but suspects other countries may be unaware of the spread to birds.

7.

According to the Brazilian Ministry of Health… a.) b.) c.) d.)

8.

Which of the following statements is FALSE? a.) b.) c.) d.)

9.

…The United States has counted 522 fatalities. …more people have died in Brazil than in the USA. …more people have died in the USA than in Brazil. …Brazil is the 13th worst country for swine flu deaths.

52 pregnant women have died of Swine Flu in Brazil. Argentina has reported 386 H591 related deaths. Swine flu was first discovered in Mexico in April. The USA is one of the most severely affected countries annually.

Which of the following statements is TRUE? a.) Young people are less likely to be affected by swine flu than old people and pregnant women. b.) Students in Sao Paulo have been asked to stop going to weekend classes. c.) Students in Sao Paulo have stopped playing volleyball. d.) Brazil has had less cases of swine flu this winter than expected.

10. When will most US citizens be protected by the vaccine, and why? a.) b.) c.) d.)

Early November, because this is when the vaccine is available Mid October, because this is when the vaccine is available November, because it takes time to develop immunity following the vaccine Next June, because there is likely to be a pandemic at this time

PLEASE TURN OVER

READING PASSAGE B

Risks and Benefits of Hormone Replacement Therapy Paragraph 1

Several recent large studies have provoked concern amongst both health professionals and the general public regarding the safety of hormone replacement therapy (HRT). This article provides a review of the current literature surrounding the risks and benefits of HRT in postmenopausal women, and how the data can be applied safely in everyday clinical practice. Paragraph 2

10

Worldwide, approximately 47 million women will undergo the menopause every year for the next 20 years.1 The lack of circulating oestrogens which occurs during the transition to menopause presents a variety of symptoms including hot flushes, night sweats, mood disturbance and vaginal atrophy, and these can be distressing in almost 50% of women. Paragraph 3

For many years, oestrogen alone or in combination with progestogens, otherwise known as hormone replacement therapy (HRT), has been the treatment of choice for control of problematic menopausal symptoms and for the prevention of osteoporosis. However, the use of HRT declined worldwide following the publication of the first data from the Women’s Health Initiative (WHI) trial in 2002.2 Paragraph 4

The results led to a surge in media interest surrounding HRT usage, with the revelation that 20 there was an increased risk of breast cancer and, contrary to expectation, coronary heart disease (CHD) in those postmenopausal women taking oestrogen plus progestogen HRT. Following this, both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II)3,4 and the Million Women Study5 published results which further reduced enthusiasm for HRT use, showing increased risks of breast cancer5 and venous thromboembolism (VTE),4 and the absence of previously suggested cardioprotective effects3 in HRT users. The resulting fear of CHD and breast cancer in HRT users left many women with menopausal symptoms and few effective treatment options. Paragraph 5

Continued analysis of data relating to these studies has been aimed at understanding whether or not the risks associated with HRT are, in fact, limited to a subset of women. A 30 recent publication from the International Menopause Society6 has stated that HRT remains the first-line and most effective treatment for menopausal symptoms. In this article we examine the evidence that has contributed to common perceptions amongst health professionals and women alike, and clarify the balance of risk and benefit to be considered by women using HRT. Paragraph 6

One of the key messages from the WHI in 2002 was that HRT should not be prescribed to prevent age-related chronic disease, in particular CHD. This was contradictory to previous advice based on observational studies. However, recent subgroup analysis has shown that in healthy individuals using HRT in the early postmenopausal years (age 50–59 years), there was no increased CHD risk and HRT may potentially have a cardioprotective effect.8

Paragraph 7

Recent WHI data has suggested that oestrogen-alone HRT in compliant women under 60 years of age delays the progression of atheromatous disease (as assessed by coronary arterial calcification).9 The Nurses Health Study, a large observational study within the USA, 40 demonstrated that the increase in stroke risk appeared to be modest in younger women, with no significant increase if used for less than five years. Paragraph 8

Hormone replacement therapy is associated with beneficial effects on bone mineral density, prevention of osteoporosis and improvement in osteoarthritic symptoms. The WHI clearly demonstrated that HRT was effective in the prevention of all fractures secondary to osteoporosis.11 The downturn in HRT prescribing related to the concern regarding vascular and breast cancer risks is expected to cause an increase in fracture risk, and it is predicted that in the USA there will be a possible excess of ≥43,000 fractures per year in the near future.11 Paragraph 9

The WHI results published in 2002 led to a significant decline in patient and clinician 50 confidence in the use of HRT. Further analysis of the data has prompted a re-evaluation of this initial reaction, and recognition that many women may have been ‘denied’ treatment. Now is the time to responsibly restore confidence regarding the benefit of HRT in the treatment of menopausal symptoms when used judiciously. Hormone replacement therapy is undoubtedly effective in the treatment of vasomotor symptoms, and confers protection against osteoporotic fractures. Paragraph 10

The oncologic risks are relatively well characterised and patients considering HRT should be made aware of these. The cardiovascular risk of HRT in younger women without overt vascular disease is less well defined and further work is required to address this important question. In the interim, decisions regarding HRT use should be made on a case-by-case basis following informed discussion of the balance of risk and benefit. The lowest dose of hormone necessary to alleviate menopausal symptoms should be used, and the prescription reviewed on a regular basis. 60

Dr C Hardie, Dr C Bain, Dr M Walters

Risks and Benefits of Hormone Replacement Therapy 11. Which statement is the closest match to the description of the recent studies in Paragraph 1? a.) They demand a prompt review of current HRT practices. b.) They have shown that HRT can be used safely in clinical practice. c.) They have decreased the confidence of doctors and the public in HRT. d.) They have given menopausal women a new confidence to undergo HRT. 12. Which statement is the closest match to the description of projected menopause figures in Paragraph 2? a.) 47 international women will enter menopause annually for the next 20 years. b.) All women are likely to go through menopause if they live long enough. c.) 47 million women globally will enter menopause each year for the next 20 years. d.) Most women will succumb to menopause if they do not undertake HRT. 13. What cause does the article cite for the symptoms of menopause? a.) b.) c.) d.)

Lack of circulation Age Low progesterone levels Low circulating estrogen levels

14. What has been the effect of the 2002 WHI study? a.) HRT has become less popular. b.) HRT has increased in popularity as the treatment of choice for problematic menopause symptoms. c.) There has been an increase in combined estrogen and progesterone therapy. d.) The womenʼs health initiative has since been established to investigate HRT. 15. Why were many women left with menopausal symptoms and no effective treatment? a.) b.) c.) d.)

They were unable to afford HRT treatments. They were concerned about coronary heart disease and breast cancer. They were concerned about breast cancer and venous thromboembulism. They were concerned about breast cancer and the cardioprotective effects.

PLEASE TURN OVER

Which of these statements is a TRUE summary of Paragraph 5?

16. a.) Surveys since WHI have attempted to find out if the WHI results are representative. b.) Results of past surveys are only valid for a subset of women, whether or not the public is aware of this. c.) The present study aims to show that HRT is safer than previously believed. d.) Women should ask their doctors to clarify the balance of risks and benefits of HRT. Which study showed an increased risk of VTE? 17. a.) b.) c.) d.)

The Nurses Health Study The Million Women Study The Womenʼs Health Initiative Study The WISDOM Study

18. Which of the following does the article recommend HRT should NOT be used to treat? a.) Vasomotor symptoms b.) Atheromatous disease c.) Age-related chronic disease d.) Osteoarthritic symptoms 19. Why were women “denied treatment”? (Paragraph 9) a.) b.) c.) d.)

Due to the decline in patient confidence in HRT Due to the results of studies including the WHI study Due to judicious use of HRT Due to a re-evaluation of this initial reaction

20. Which statement is NOT a recommendation of the present article? a.) b.) c.) d.)

Further study should be made into oncological risks of HRT Further study should be made into cardio vascular risks of HRT Doctors should now reassure their patients that HRT can be safe Doctors should prescribe the lowest effective dose for menopause symptoms

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Reading Test 1 – Answers Part A

Part B

1.

life expectancy

1. B

2.

2

2. C

3.

Sub Saharan Africa

3. B

4.

dementia

4. A

5.

Alzheimer’s Disease International

6.

2.4.2 million

7.

4.6 million

8.

non-fatal stroke

9.

60

10.

double

11.

Latin America

12.

80%

13.

2050

12. C

14.

risk exposure

13. D

15.

health transition

14. B

16.

sedentary lifestyles

15. C

17.

public health measures

16. D

18.

adult daycare centres

17. B

19.

supervision

18. C

20.

institutional care

19. A

21.

agitated

22.

rule out

23.

educate

24.

distraction

25.

Canadian

26.

onset

27.

4 years

5. B 6. C 7. D 8. B 9. A 10. A 11. C

20. A