TEXT A Tobacco: Tobacco smoking is also an important risk factor for cardiovascular diseases. Currently, an estimated 967 million of the world’s 7.6 billion smokers liv in the developing world. Tobacco smoking increased among men, followed by women, in industrialized nations in the last century, and has subsequently declined in some nations such as Canada, the United States, and the United Kingdom. Descriptive models based on historical patterns in the industrialized world predict a reduction in the number of male smokers and an increase in the number of female smokers in the developing world over the coming decades. However, there have been major recent transformations in global tobacco trade, marketing, and regulatory control. As a result, tobacco consumption among men and women in most nations is primarily determined by opposing industry efforts and tobacco control measures, and by the socio¬ cultural context, rather than national income.

TEXT B. BMI: The observed rapid BMI increase with national income indicates that preventing obesity, which may be more effective than reacting after it has occurred, should be a priority during economic growth and urbanization of a nation. Overweight and obesity are also important because they cause a number of non- cardiovascular outcomes including cancers, diabetes, and osteoarthritis which cannot be addressed by reducing risk factors such as blood pressure and cholesterol. Current _intervention options for obesity in principle include those that reduce calorie intake and increasing energy expenditure of a population through urban design which incorporates space for outdoor activities.

TEXT C. Current Research (WHO, 2018)
Background: Cardiovascular diseases and their nutritional risk factors-including overweight and obesity, elevated blood pressure, and cholesterol-are among the leading causes of global mortality” and morbidity, and have been predicted to rise with economic development in countries and societies throughout the world.
Methods and Findings: We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about 1$ 5,000 (international dollars) and peaked at about 1$ 12,500 for females and I$ 17,000 for males. Cholesterol’s point of inflection and peak were at higher income levels than those of BMI (about 1$ 8,000 and 1$ 18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not significantly affected by the economic factors considered.
Conclusions: When considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low- and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by measures to promote awareness of the causes of high blood pressure and cholesterol.

TEXT D. Health Repercussions of Western Lifestyle
Factors associated with the increase of these illnesses appear to be, paradoxically, things which many people would regard as lifestyle improvements. They include:
• Less strenuous physical exercise, often through increased use of a car
• Easy accessibility in society to large amounts of low-cost food
• More food generally, with much less physical exertion expended to obtain a moderate amount of food
• More high fat and high sugar foods in the diet are common in the affluent developed economies
• Higher consumption of meat and dairy products -Higher consumption of grains and white bread
• More foods which are processed, cooked, and commercially provided (rather than seasonal, fresh foods prepared locally at time of eating)

QUESTIONS 1-7. For 1-7, decide which text (A, B, C or D): in which text can you find information about
1. from where did the data for the research were collected?
2. name one important risk factor for cardiovascular diseases?
3. what does the observed rapid BMI increase with national income indicate?
4. which types of foods are common in the affluent developed economies?
5. what can cause a number of non- cardiovascular outcomes? —
6. what was the influence of economic factors on the mean population blood pressure? _
7. how many smokers are there in the developing world?

QUESTIONS 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.
8. Who conducted the current research on diseases of affluence?
9. How many countries contributed the data for the research?
10. What is the efficient way to minimize diseases of affluence?
11. What is the basis of description models that predicts number of smokers?
12. What is the estimated population of the world?
13. Where did tobacco smokers increase in the last century?

QUESTIONS 14-20. Complete each of the sentences, 14-20, with a word or short phrase.
14. Cholesterol is one among the leading causes of _____________________ and morbidity.
15. Current intervention option for ____________________ in principle include reducing calorie intake.
16. Overweight and obesity can cause _____________________ outcomes including cancers, diabetes, and osteoarthritis.
17. Preventing obesity should be apriority during economic growth and __________________ of a nation.
18. There have been major recent transformations in global ________________________ marketing, and regulatory control.
19. There was an inverse relationship between BMl/cholesterol and the food share of __________________
20. Factors of these illnesses -are things which many people would regard as ______________________

PART B. Choose the answer (A, B or C).

Ultrasound Machines: Diagnostic ultrasound machines are used to give images of structures within the body. The diagnostic machine probes, which produce the ultrasound, come in a variety of sizes and styles, each type being produced for a particular special use. Some require a large trolley for all the parts of the unit, while the smallest come in a small box with only an audio loudspeaker as output. They may be found in cardiology, maternity, outpatients and radiology departments and will often have a printer attached for recording images. Unlike X-rays, ultrasound poses no danger to the human body.

1. The manual informs us that the ultrasound machines
A. are used to give images of structures with the body.
B. have a printer attached for recording images.
C. poses negligible danger to the human body.

X-Ray Machines: X-rays are high energy electromagnetic waves. The transformer produces a high voltage that directs electrons onto a target in the machine head. X-rays are produced by the target and are directed into beams by a collimator towards the human body. Soft body tissue absorbs less X-rays, i.e., passes more of the radiation, whereas bone and other solids prevent most of the X-rays from going through. Users must ensure proper radiation safety protocols and supervision are in place.

2. The guidelines establish that the healthcare professional should
A. must ensure proper safety protocols.
B. evaluate the radiation absorbed by bones and tissues.
C. respect the wishes of the patient above all else.
Biomedical waste: Biomedical waste is all waste tissue and body fluids, including clinical items contaminated with these. It is covered under the rules framed by the Central Pollution Control Board. Hospital management must take steps to segregate, manage and safely dispose of this waste. Equipment users must be aware of the systems that exist for this and follow local procedures. Most importantly, users must keep biomedical waste separate from other waste.

3. The purpose of this email is to
A. inform biomedical waste rules are framed by the Central Pollution Control Board.
B. inform users must beware of the systems that exist and follow local procedures.
C. inform users must keep biomedical waste separate from other waste.

Hygienic requirements for cleaning: All healthcare and social care facilities are wet cleaned daily and even more frequently if necessary. According to the nature of the operation, the floor must be suitable for this method of cleaning. In operating theatres using invasive procedures, cleaning is carried out both pre- and post-surgery for each patient. Intensive care units and the rooms for collecting biological material are cleaned three times a day. The frequency of cleaning in other workplaces corresponds to the nature of the operation. In the event of cleaning by a subject other than the healthcare or social care facility provider, the designated worker must proceed according to the contract and the disinfecting or cleaning rules.

4. The manual informs us that the intensive care units
A. are cleaned thrice a day
B. are wet cleaned more frequently
C. frequency of cleaning corresponds to nature of operation

Decontamination: Decontamination procedures include mechanical cleaning, which removes impurities and reduces the presence of microorganisms. In the event of contamination by biological material, it is necessary to include mechanical cleaning before the disinfection process. Detergents with a disinfectant effect are applied manually or by washing and cleaning machines, pressure guns, ultrasonic devices, etc. All tools and equipment must be kept clean. Cleaning machines and other equipment are used in accordance with the manufacturer’s instructions, including checks of the cleaning process.

5. The notice is giving information about
A. cleaning process before disinfection process
B. cleaning process before decontamination process
C. cleaning process after disinfection process

Physical disinfection
• Boiling under atmospheric pressure for at least 30 minutes.
• Boiling in pressurized containers for at least 20 minutes.
• Disinfection in equipment at a temperature determined by parameter A. The equipment must guarantee to reduce living microorganisms on the disinfected object at a given temperature to a predetermined level suitable for further use.

6. What must all staff involved in the physical disinfection process do?
A. Boil under atmospheric pressure for at least 20 minutes
B. Boil under atmospheric pressure for at least 30 minutes
C. Boil in pressurized containers for at least 30 minutes

PART C. TEXT 1. Choose the answer (A, B, C or D) BREAST CANCER AND THE ELDERLY

Paragraph 1: Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70 years or older at diagnosis. Despite these statistics, few breast cancer trials take these older women into account. Considering that · nowadays a 70-year-old woman can expect to live for at least another 12-16 years, this is a serious gap in clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and doctors need to know whether cancer treatment will affect or increase the risk for these diseases.

Paragraph 2: In 1992, guidelines were issued to the Uppsala/Orebro region in Sweden (with a population of 1.9 million) that all women with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to assess data from the register to see whether women of all ages were receiving equal cancer treatment.

Paragraph 3: They compared the 5-year relative survival for 9,059 women with breast cancer aged 50-84 years. They divided them into two age groups: 50-69 years, and 70-84 years. They also categorized the women according to the stage of breast cancer. They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment-Le., surgical, oncological (radiotherapy, chemotherapy, or hormonal)-and the type of clinic the patients were treated 1n.

Paragraph 4: They found that women aged ·70-84 years had up to a 13% lower chance of surviving breast cancer than those aged 50-69 years. Records for older women tended to have less information on their disease, and these women were more likely to have unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients.

Paragraph 5: Current guidelines are vague about the use of chemotherapy in older women, since studies have included only a few older women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if the tumours did not show signs of hormone sensitivity. The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an alternative.

Paragraph 6: The researchers admit that one drawback of their study is that there was little information on the other diseases that older women had, which might explain why they were offered treatment less often than younger patients. However, the fact remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger women- despite accounting for one-third of all breast cancer cases in the country- and those older than 74 years are not screened at all. Eaker and co-workers’ findings indicate that older women are urgently in need of better treatment for breast cancer and guidelines that are more appropriate to their age group. Developed countries, faced with an increasingly aging population, cannot afford to neglect the elderly.

Q1. The main idea presented in paragraph one is that. …..
a. only older women need to be concerned about breast cancer.
b. breast cancer trials seldom consider older women.
c. breast cancer is more common than other diseases in older woman.
d. older women do not take part in breast cancer trials.
Q2. Regarding cancer treatment, it can be concluded that. …
a. doctors know cancer treatment will increase the risk of disease in elderly patients.
b. cancer treatments may be a risk for all elderly people
c. it is unknown whether or not cancer treatments will affect the treatment of other diseases in elderly people.
d. older women are less likely to have other diseases
Q3. 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that.
a. Sweden has a population of 1.9 million.
b. women with breast cancer need to register their condition to ensure they receive equal treatment.
c. identical breast cancer treatment should be available to women of all ages.
d. all women with breast cancer should have access to equivalent breast cancer treatment.
Q4. Which of the following was not part of Sonja Eaker and her colleagues research?
a. Comparing ability of breast cancer cells to increase in number.
b. Grouping woman according to their survival rate.
c. Identifying differences in treatment methods.
d. Splitting the groups based on age.
QS. Findings by the researchers indicate that …….
a. older women are less likely to have chemotherapy recommended.
b. older women prefer hormone treatment to breast-conversing surgery.
c. older women have fewer lymph nodes.
d. older women respond better to chemotherapy than to hormone treatment.
Q6. The word vague is paragraph 5 means ……
a. uncertain
b. unclear
c. unknown
d. doubtful
Q7. One limitation of the study is that …..
a. older women are treated less often than younger women.
b. older women have a lower incidence of breast cancer.
c. younger women are treated more often than older women.
d. there is a lack of information on other diseases which older women have.
Q8. Which of the following statements best represents the view expressed by the writer at the end of the article?
a. Due to ageing population in developed countries, the needs of the elderly must not be ignored.
b. Older women need more appropriate treatment to suit their age.
c. Developed countries have neglected the elderly for too long.
d. It is too expensive treat the elderly.

PART C. TEXT 2. Choose the answer (A, B, C or D) PARENTS, KIDS & VEGIES

Paragraph 1: Most parents have waged epic battles with their kids over eating vegies. But if they don’t clean their plate of the last brussels sprout, does it really matter? Vegetables are behind some of the greatest battles between parents and children. Most parents have dinnertime horror stories involving small bits of vegetable and lots of screaming, and while these stories can be entertaining, the research showing how few vegies our kids are eating is not.

Paragraph 2: The 2009 Australian Institute of Health and Welfare national report card found that a whopping 78 per cent of 4–8-year-olds, 86 per cent of 9-13 year¬ olds and 95 per cent of 14–16-year-olds are not eating the recommended daily servings of vegetables. Take out potatoes, which most kids eat as chips, and the percentage of kids not getting the nutrition they need jumps to 97, 98 and 100 per cent respectively. Other research has made similar findings.

Paragraph 3: But Australian children are hardly going to starve if they don’t eat vegetables and it’s not easy for parents to keep cooking meals that are left on the plate or worse, tipped on the floor. Does it really matter if our kids don’t eat their greens? Professor Louise Baur, paediatrician and director of weight management services at The Children’s Hospital at Westmead, says we all need to eat a wide variety of foods – including vegetables – and children are no different. Research shows vegetable consumption can help prevent chronic diseases such as heart disease, type 2 diabetes and a range of cancers.

Paragraph 4: According to Australia’s dietary guidelines, children aged between four and seven should be eating two to four serves of vegetables daily. Eight- to 11-year-olds should be eating an extra serve; teenagers should have between four to six serves every day. One serve of vegetables is one cup of raw salad vegetables, one medium potato or half a cup of cooked vegetables or legumes.

Paragraph 5: In the short-term, children who don’t eat vegetables can end up with dental issues, constipation (especially if they skip on fruit as well) and on rare. occasions nutritional deficiencies, Baur says. But perhaps more importantly, we tend to develop our eating habits in childhood, so if you’re not eating vegetables and other healthy foods as a child then you are less likely to do so as an adult.

Paragraph 6: Excess weight is also a problem; between 6-8 per cent of school age children in Australia are obese and at least another 17 per cent are overweight. You won’t automatically put on weight if you don’t eat vegetables, Baur says, but children who don’t eat vegetables are often eating foods that are high in saturated f ats, sugar and salt. Children who are overweight are more likely to become overweight or obese adults, who are then at greater risk of chronic diseases.

Paragraph 7: And while the most hardened young vegie hater might enjoy an apple, banana or piece of watermelon, Baur says fruit doesn’t contain the iron and other minerals found in vegetables, and it also contains more sugars. While fruit is an important part of a healthy diet, the dietary guidelines suggest kids under 12 only need one to two serves a day. So, we know that kids need their vegies, but getting them to eat a mouthful, let alone several cups can be a challenge.

Paragraph 8: Nutritionist Dr Rosemary Stanton suggests nutrition should be a whole family affair; you can boost your child’s vegetable intake by eating your evening meal together at the dinner table, preferably with the television off. “Vegetables have traditionally been eaten mainly at dinner and with many families no longer having a family meal, many kids get themselves something to eat – often instant noodles, pizza or some kind of pasta dish (rarely with vegies),” Stanton says.

Paragraph 9: Children are also more likely to eat and enjoy vegetables, and other healthy foods, if they find them interesting, says Stanton. “Several studies show that when kids grow vegies or attend a school with a kitchen garden, they tend to eat more vegies … For those in flats, there are community gardens in some areas, or if they have a balcony lettuce, herbs, cherry tomatoes etc …can all be grown in pots.” ·

Paragraph 10: You can also pique your child’s interest in vegetables by including them in a range of tasks, such as grocery shopping, going to markets or by getting them to help prepare meals. Small children can toss a salad (you can rewash any salad leaves that end up on the floor), and older children can take on more difficult tasks, for example peeling and cutting vegetables. But perhaps the most important thing parents can do is model healthy eating. Research has shown children’s eating patterns are affected by the family’s eating behaviour. Lisa Renn, spokesperson for the Dietitians Association Australia, encourages parents to be persistent.

Paragraph 11: She says there are many easy and crafty ways to get vegies off your children’s plates and into their mouths:
• grate extra vegetables and add them to a favourite pasta sauce
• make green mash, add spinach or rocket when mashing potato
• serve vegie sticks with dips (think avocado, pumpkin or sweet potato) and other snacks
• add extra vegetables or legumes to your next soup or stew
• make muffins using vegetables – com, pumpkin and sweet potato all work well.

Paragraph 12: She also suggests the scattergun approach: offering a wide variety of vegetables (the more different colours the better) in small amounts throughout the day, not just at dinner time. There’s no denying these suggestions require time, effort and creative ‘marketing’. Ultimately, says Renn, “you do what you can do, get them in where you can, be as inventive as possible and be persistent”.

QUESTIONS
Q1. According to the passage what is the reason behind the battle between parents & children?
a. over eating of vegies
b. not cleaning
c. vegetables
d. not eating vegies
Q2. Who stand first is avoiding vegies from daily servings?
a. 4-8 years
b. Teen years
c. 14-16 years
d. Kids
Q3. Why do parents feel discomfort in cooking vegetables?
a. Children won’t eat them
b. Vegetables will be in plates/ floors
c. Children will starve
d. b and c.
Q4. Who cannot be eliminated according to Prof. Louise?
a. diabetic patients
b. children
c. children prone to cancer
d. a and c
QS. Along with a potato how munch vegetables should be taken in a day?
a. a cup
b. a cup of cooked veggies
c. none of the above
d. a and b
Q6. Which has the less possibility to occur with eating les veggies?
a. Dental issues
b. Constipation
c. Deficiency
d. None
Q7. What will automatically happen when you are not eating vegetables?
a. put on weight
b. reduce in weight
c. occurrence of obese
d. nothing will happen
Q8. Who needs 2 serves of vegetables a day according to the passage?
a. 4-7 years
b. 8-11years
c. Below 12 years
d. A and c

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