PART A

TEXT 1:Tobacco Smoking Statistics from the Australian Institute of Health and Welfare

Tobacco smoking is the single most important preventable cause of ill health and death in Australia. Tobacco smoke contains over 7,000 chemicals, of which over 70, cause cancer. Lung cancer, chronic obstructive airways disease and coronary heart disease are the 3 main diseases linked to tobacco smoking.

Smoking-related diseases killed 14,900 Australians in the financial year 2004–05. This equals 40 preventable deaths every day. Smoking resulted in over 750,000 days spent in hospital and cost $670 million in hospital costs in the financial year 2004–05.

Smoking kills more men than women – 9,700 men compared to 5,200 women. Cancer is the number one cause of tobacco-related death in men (57 per cent) and women (51 per cent), with lung cancer accounting for around 75 per cent and 72 per cent of cancers for men and women respectively. Lung cancer currently causes the most cancer deaths in Australia and this is due mainly to smoking.

The trend for tobacco smoking is dropping with 12% of people aged 14 and older smoking daily in 2016, which is a 24% reduction since 1991. The number of young people who start smoking is also reducing. In 2010, the average age when 14–24 year-olds smoked their first full cigarette was 14.2, but it was 16.3 in 2016. In 1995, 31% of adults smoked in a home where there were dependent children. In 2016, this was down to just 2.8%.

TEXT 2 Why do people smoke?

Cigarettes contain nicotine which does not cause the health issues linked to cigarette smoking but is highly addictive. In small amounts, nicotine causes pleasant feelings which makes the smoker want more. It does not take long before the time between cigarettes gets less, because the smoker is keen to get the pleasant feelings they had before. When a person becomes addicted to nicotine they soon start to have bad

feelings like being irritated and edgy when they are ready for another boost of nicotine.

Most smokers started when they were teens and those who have friends and/or parents who smoke are more likely to start smoking than those who don’t.

The tobacco industry spends billions of dollars each year to create and market their products that show smoking as exciting, glamorous, and safe. Tobacco use is also shown in video games, online, and on TV. Movies showing smokers are another big influence and studies show that young people who repeatedly see smoking in movies are more likely to start smoking.

Widespread advertising, price breaks, and other promotions for cigarettes have been big influences in the past but now many governments are bringing in a lot of ways to reduce the number of people who smoke.

In Australia, the government:

•does not allow cigarette advertising

•has had cigarettes moved to covered cupboards so they cannot be seen in places like dairies, petrol stations and supermarkets

•has gradually increased the amount of tax added to a packet of cigarettes

TEXT 3 Stopping smoking is not easy

Common symptoms people have when they stop smoking include:

•Cravings for nicotine which may be strong at first but they

usually only last a few minutes

• restlessness and trouble concentrating or sleeping

• irritability, anger, anxiety, depression

• increase in appetite and weight gain

Less common symptoms include:

• cold symptoms such as coughing, sore throat and sneezing

• constipation

• dizziness or light-headedness

• mouth ulcers.

The benefits of quitting smoking are:

• immediate health benefits

• a dramatic reduction the risk of smoking-related diseases

Statistics include:

• Quitting before 30 years of age reduces the risk of lung cancer by 90 per cent

• After 15 years of being a non-smoker, the risk of stroke is reduced to that of a person who has never smoked

• Within two to five years of quitting, there is a large drop in the risk of heart attack and stroke

TEXT 4. Different support to stop smoking in Australia

• ‘Cold turkey’ is giving up smoking suddenly, without using medications.

• The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce withdrawal symptoms from nicotine.

• Nicotine replacement therapy including patches, gum and lozenges.

• QuitCoach is an online tool developed to assist in quitting smoking.

• Quitline is a telephone service available to smokers who want to quit.

• Acupuncture involves treatment by applying needles or surgical staples to different parts of the body.

• Hypnotherapy has not been shown to increase the likelihood of quitting in the long term, although counselling or other treatments that may be offered with it can be helpful to some smokers

E-Cigarettes/ Vaping are increasingly being used instead of traditional cigarettes. However, there is limited evidence available on their quality, safety, efficacy for smoking cessation or harm reduction, and the risks they pose to population health.

In March 2015, the Chief Executive Officer (CEO) of Australia’s National Health and Medical Research Council (NHMRC) issued a statement stating that: “there is currently insufficient evidence to conclude whether e-cigarettes can benefit smokers in quitting, or about the extent of their potential harms. It is recommended that health authorities act to minimise harm until evidence of safety, quality and efficacy can be produced”.

Questions 1-7 For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any letter more than once. In which text can you find information about

1 E-cigarettes and their role in stopping smoking? __________________

2 Statistics about smoking in Australia? __________________

3 The benefits of quitting smoking? __________________

4 The different support to stop smoking in Australia? _____________

5 The addictive features of nicotine? __________________

6 The 3 main diseases linked to tobacco smoking? __________________

7 The common symptoms people have when they stop smoking? __________________

Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8 What bad feelings might a person have when they are ready for another boost of nicotine? ________

9 What therapy includes patches, gum and lozenges? __________________

10 How old is a person if their risk of lung cancer reduces by 90 per cent if they stop smoking? _______

11 What percentage of adults smoked in a home where there were dependent children in 2016?

12 Who does not allow cigarette advertising? __________________

13 Who should act to minimise harm until evidence of safety, quality and efficacy of e-cigarettes can be produced__________________

14 Young people are more likely to start smoking if they see what repeatedly? __________________

Questions 15-20 Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

15 12% of people aged 14 and older smoked daily in 2016, which is a___________reduction since 1991

16 Common symptoms of nicotine withdrawal include_________________and depression

17 Cigarettes contain nicotine which does not cause the___linked to cigarette smoking but is highly addictive. 18 Smoking kills more_________________

19 The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce__from nicotine. 20 The Government in Australia has_________________the amount of tax added to a packet of cigarettes.

PART B

TEXT 1 The MIST Therapy system for the promotion of wound healing

The MIST Therapy system shows potential to enhance the healing of chronic, ‘hard-to-heal’, complex wounds, compared with standard methods of wound management. If this potential is substantiated, then MIST could offer advantages to both patients and the hospitals.

However, comparative research has yet to be carried out. Further investigation is necessary to reduce uncertainty about the outcomes of patients with chronic, ‘hard-to-heal’, complex wounds treated by the MIST Therapy system compared with those treated by standard methods of wound care. This research should define the types and chronicity of wounds being treated and the details of other treatments being used. It should report healing rates, durations of treatment (including debridement) needed to achieve healing, and quality of life measures (including quality of life if wounds heal only partially).

Question 1) Why should further research be carried out on the MIST Therapy system?

a) To investigate the range of wounds that this system can help to treat

b) To make sure that it offers improvements over the usual treatment option

c) To discover if this system can avoid deleterious outcomes for chronic wounds

TEXT 2 Assessing Risk and Prevention

Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 45% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall.

All people aged 65 or older are covered by all guideline recommendations as they have the highest risk of falling. According to the guideline recommendations, all

people 65 or older who are admitted to hospital should be considered for a multifactorial assessment for their risk of falling during their hospital stay.

Question 2) What does the article tell us about the risk of falling?

a) People over 65 need extra facilities to help them avoid falls

b) More people over 65 fall in hospital environments compared with other places

c) Only a minority of people over 65 fall at least once a year

TEXT 3 Dealing With Hazmat

One of the most challenging aspects of providing emergency medical care is attending to patients who have been contaminated with hazardous materials. HAZMAT is a term used to describe incidents involving hazardous materials or specialized teams who deal with these incidents. Hazardous materials are defined as substances that have the potential to harm a person or the environment upon contact. These can be gases, liquids, or solids and include radioactive and chemical materials.

The potential for exposure to hazardous materials in the United States is significant. More than 60,000 chemicals are produced annually in the United States, of which the US Department of Transportation considers approximately 2000 hazardous. More than 4 billion tons of chemicals are transported yearly by surface, air, or water routes.

Question 3) According to this article, what is HAZMAT?

a) Liquid, gaseous or solid materials that are bad for the environment

b) Events where harmful substances are released and the groups that deal with the aftermath

c) Toxic chemicals that are transported by water, land or air.

TEXT 4 How Does Blood Clot?

Within seconds of a blood vessel cut, the damaged tissue causes platelets to become ‘sticky’ and gather together around the cut. These ‘activated’ platelets and the damaged tissue release chemicals which react with other chemicals and proteins in the plasma, called clotting factors. A complex series of reactions involving these clotting factors then occurs rapidly. Each reaction triggers the next reaction and this process is known as a cascade.

The final chemical reaction is to convert a clotting agent called fibrinogen into thin strands of a solid protein called fibrin. The strands of fibrin form a meshwork and trap blood cells which form into a solid clot.

Question 4) According to this article, what is a cascade?

a) A series of events

b) The process that occurs when platelets become sticky

c) The reaction that precedes the formation of fibrin

TEXT 5 At the onset of a migraine attack, the patient should be given a full dose of painkiller. For an adult this means 900 mg aspirin (usually three 300 mg tablets) or 1000 mg of paracetamol (usually two 500 mg tablets). This dose can be repeated every four hours if necessary. Soluble tablets have the advantage of being absorbed more quickly than solid tablets.

Codeine and medicines containing codeine, such as co-codamol, are not recommended for the treatment of migraine. This is because codeine can make feeling sick (nausea) and being sick (vomiting) worse, which can aggravate the migraine. They are also more likely than paracetamol or aspirin to cause a condition called medication-overuse headache if they are used frequently.

Question 5) What do we learn about migraine treatment from this article?

a) Paracetamol doses should not exceed 1000mg  

b) Aspirin can cause nausea and/or vomiting

c) Codeine can provoke conditions other than migraine

TEXT 6 Not all patients can independently move or position themselves in bed and their immobility may be due to a wide range of factors. Positioning patients in good body alignment and changing position regularly are essential aspects of nursing practice. It is vital to provide meticulous care to patients who must remain in bed. Healthcare givers’ measures should ensure to preserve the joints, bones and skeletal muscles and must be carried out for all patients who require bed rest.

Positions in which patients are placed, methods of moving and turning should all be based on the principles of maintaining the musculoskeletal system in proper alignment. In addition, the health care provider must also use good body mechanics when moving and turning patients to preserve his or her own musculoskeletal system from injury.

Question 6) What information does the article give us about positioning patients?

a) Healthcare givers should position immobile patients in accordance with the doctor’s instructions

b) Positioning patients is a fundamental part of a nurse’s job

c) Improper musculoskeletal manipulation can lead to immobility

PART C TEXT 1

Once the preserve of hippies and activists, veganism has now hit the mainstream. Forgoing meat, dairy and eggs is more popular than ever. While it’s positive that people are taking a more ethically-conscious approach to food shopping, what nutrients could vegetarians and vegans put themselves at risk of losing out on? And how can you approach animal-free consumption in a healthy way?

Generally, people choose to be vegetarian or vegan for ethical reasons or because they want to improve their health. A vegan diet is usually low in saturated fats and rich in fruit and vegetables. ‘Meat-free Monday’ is a UK campaign, launched by Paul McCartney in 2009, to encourage people to reduce their environmental impact and improve their health by having at least one meat-free day each week. More and more people are realising this is far more manageable than they first thought. When you stop thinking a meal needs meat to be complete, vegetarian options start to look a lot more appealing.

If you’ve decided to give up meat and have vowed to eat more vegetables, that’s a good first step. But vegetarians and vegans do have to be careful they’re not missing out on nutrients most easily found in meat and dairy sources. Protein is one of them. Protein builds and repairs tissues and is a building block of bone, muscles, skin and blood. It isn’t stored in your body, so you need to make sure you’re getting enough from your diet.

Unfortunately for vegetarians, meat is a rich source of this macronutrient. “Whilst many plant-based foods contain protein too, they may not contain protein in the correct balance that the body needs. Therefore, vegetarians need to make sure they eat a combination of foods to achieve the right protein balance,” says Dr Jan Sambrook, a doctor who specialises in nutrition. Luckily, you can also find protein in grains, pulses and dairy products. “If you eat any two of these, the protein will balance,” reveals Sambrook. “This doesn’t necessarily need to be within a single meal, as was previously thought. Examples of protein-balanced meals include cereal with milk, or baked potato with beans and cheese.”

A balanced vegetarian or vegan diet generally gives you plenty of vitamins. But if you’re not sure, there are some foods to look out for when it comes to specific nutrients. “Vitamin A is found in eggs and dairy products. A different form of the vitamin, called beta carotene, is found in dark green leafy vegetables and in coloured fruits and vegetables such as mango, carrots and red peppers,” explains Sambrook. Vitamin D, ‘the sunshine vitamin’, is also really important. It helps your body absorb calcium and is also needed for our muscles to work properly. More recently, vitamin D deficiency has been associated with numerous conditions, from heart disease, to dementia and multiple sclerosis. “Vitamin D is mainly made in our skin by the action of sunlight. However, it is also found in dairy products, mushrooms and in fortified cereals and margarine,” says Sambrook. “Oily fish and eggs are also among the top dietary sources of vitamin D, so if you’re adopting a vegan diet you’re less likely to be getting enough.”

Most of the minerals we need are found in a wide variety of foods and anyone eating a balanced diet can obtain enough of them. However, vegetarians and vegans must make sure they’re getting enough calcium and iron. Recently, the National Osteoporosis Society (NOS) warned that the popularity of ‘clean eating’ and other diets where major foods groups are cut out is setting young people up for a future of weak bones. “Without urgent action being taken to encourage young adults to incorporate all food groups into their diets and avoid particular ‘clean eating’ regimes, we are facing a future where broken bones will become just the norm,” said Susan Lanham-New, a nutrition professor and clinical advisor to the NOS.

Vegans, who normally don’t consume dairy products, may find it challenging to obtain calcium in their diet. “Calcium is, however, also present in leafy green vegetables, dried figs, almonds, oranges, sesame seeds, seaweed and some types of bean,” reveals Sambrook. She explains that if non-dairy calcium is eaten with a source of vitamin D, this will help the body absorb it.

You need iron in order for your blood to carry oxygen around your body. If you don’t get enough, you become anaemic. Whether we like it or not, red meat is the richest dietary source of iron. But there are a few meat-free sources too. “Vegetarian sources of iron include pulses such as chickpeas and lentils, sprouted seeds and beans, breakfast cereals and bread. Spinach is famous for containing iron, but it is also found in other green leafy vegetables such as broccoli and kale,” explains Sambrook. She adds that your body can absorb iron from food more easily if it is eaten with vitamin C.

Questions 7-14
7) The first paragraph implies that
a) Becoming a vegan is an ethical choice

b) Hippies and activists have always been vegan

c) Food-shopping for animal-free products is essential for vegans

d) Being a vegan has potential drawbacks

8) Paul McCartney’s 2009 campaign

a) Helped the number of people who understand that meat-free cooking is possible to increase

b) Was designed to help the environment for animals

c) Showed that vegetarian meals can be more attractive than meals prepared with meat

d) Was aimed at reducing saturated fats in processed food

9) What do we learn about protein in the third paragraph?

a) The human body only has a small reserve of protein

b) Without protein, bones and muscle tissues may build more slowly

c) Levels of protein in your body need to be replenished regularly d) It is not possible to find protein in meat-free diets

10) According to the fourth paragraph, how can vegans and vegetarians consume the right kinds of protein?

a) They should stick to basic food groups, such as grains or pulses

b) They should have a mixture of food types

c) They should eat vegetables that contain the same macronutrients as dairy products

d) They can enhance their diet by taking food supplements

11) What does the fifth paragraph tell us about vitamin deficiency?

a) Vegans can get enough vitamin D from sunlight on their skin

b) Coloured fruits and vegetables are good sources of vitamin D

c) Incidence of heart disease, dementia and multiple sclerosis among vegetarians is the same as among vegans

d) Vegans have a higher than normal risk of vitamin

D deficiency

12) What is the National Osteoporosis Society (NOS) concerned about?

a) Young people can cut themselves

b) More vegetarians and vegans will develop Osteoporosis

c) There may be a rise in a specific type of injury

d) Some people are not eating enough clean food

13) What does ‘it’ (the last word of the seventh paragraph) refer to?

a) Calcium

b) Vitamin D

c) Vitamin A

d) Protein

14) What does the last paragraph say about iron?

a) Vitamin C and iron consumed together is good for iron absorption

b) Vegans should consider eating red meat

c) You can become anaemic if you don’t eat enough vegetables

d) For oxygen-carrying blood cells, vitamin C is more important than iron

PART C TEXT 2

Jennifer Millar keeps rubbish bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the pavement nearby. Keeping herself and the patch of concrete she calls home clean is her top priority. But this homeless encampment near a Hollywood freeway slip road is often littered with needles and rubbish. Rats occasionally run through, and Millar fears the consequences. “I worry about all those diseases,” said Millar, 43, who said she has been homeless most of her life.

Infectious diseases, including some that ravaged populations in the Middle Ages, are resurging in California and around the country and are hitting homeless populations especially hard. Los Angeles recently experienced an outbreak of typhus in city centre streets, a disease spread by infected fleas on rats and other animals. Officials briefly closed part of the City Hall after reporting that rodents had invaded the building. Hepatitis A, also spread primarily through faeces, has infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio and Kentucky, primarily among people who are homeless or use drugs.

Public health officials and politicians are using terms like “disaster” and “public health crisis” to describe the outbreaks, and they warn that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A, syphilis and typhus in Los Angeles.

Those infectious diseases are not limited to homeless populations, Newsom warned. “Even someone who believes they are protected from these infections may not be.” At least one Los Angeles city employee said she contracted typhus in the City Hall last fall. And San Diego County officials warned in 2017 that diners at a four-star restaurant were at risk of hepatitis A. Last month, the state announced an outbreak of typhus in Los Angeles city centre that infected nine people, six of whom were homeless. After city workers said they saw rodent droppings in City Hall, Los Angeles City Council President Herb Wesson briefly shut down his office and called for an investigation.

The infections around the country are not a surprise, given the lack of attention to housing and health care for the homeless and the dearth of bathrooms and places to wash hands, said Dr. Jeffrey Duchin, the health officer for Seattle, Washington State. “It’s a public health disaster,” he said. In his area, Duchin said, he has seen shigellosis, trench fever and skin infections among homeless populations.

In New York City, where more of the homeless population lives in shelters rather than on the streets, there have not been the same outbreaks of hepatitis A and typhus, said Dr. Kelly Doran, an emergency medicine physician and assistant professor at NYU School of Medicine. But Doran said different infections occur in shelters, including tuberculosis, a disease that spreads through the air and typically infects the lungs. These diseases sometimes get the “medieval” moniker because people in that era lived in squalid conditions without clean water or sewage treatment. People living on the streets or in homeless shelters are vulnerable to such outbreaks because their weakened immune systems are worsened by stress, malnutrition and sleep deprivation. Many also have mental illness and substance abuse disorders, which can make it harder for them to stay healthy or get health care.

One recent February afternoon, Community Clinic physician assistant Negeen Farmand walked through homeless encampments in Hollywood carrying a backpack with medical supplies. She stopped to talk to a man sweeping the sidewalks. He said he sees “everything and anything” in the gutters and hopes he doesn’t get sick. “To get these people to come into a clinic is a big thing,” she said. “A lot of them are distrustful of the health care system.” On another day, 53-year-old Karen Mitchell waited to get treated for a persistent cough by St. John’s mobile health clinic. She also needed a tuberculosis test, as required by the shelter where she was living. Mitchell, who said she developed alcoholism after a career in pharmaceutical sales, said she has contracted pneumonia from germs from other shelter residents. “Everyone is always sick, no matter what precautions they take.”

During the hepatitis A outbreak, public health officials administered widespread vaccinations, cleaned the streets with bleach and water and installed hand-washing stations and portable toilets near high concentrations of homeless people. But health officials and homeless advocates said more needs to be done, including helping people access medical and behavioural health care and affordable housing. “It really is unconscionable,” said Bobby Watts, CEO of the National Homeless Council, a policy and advocacy organization. “These are all preventable diseases.”

Questions 15-22

15) What is the most important thing for Jennifer Miller?

a) Avoiding diseases

b) Sanitizing her immediate environment

c) Finding a permanent home

d) Stopping rats and other rodents

16) What does the second paragraph tell us about Hepatitis A?

a) The recent outbreak was not confined to California

b) Hepatitis A is transmitted by fleas on rats and other animals

c) More than 1000 contracted the disease through sharing dirty needles

d) Some people in the City Hall now have Hepatitis A.

17) What problem did California Governor Gavin Newsom highlight?

a) Hepatitis A, syphilis and typhus have jumped into the homeless population

b) Politicians are not doing enough to stop the outbreak

c) The health situation in his state (California) is now a ‘disaster’

d) There is a link between public health and homelessness

18) What statistic is given in the fourth paragraph?

a) Four percent of restaurants were at risk of hepatitis A

b) Two thirds of typhus cases in Los Angeles city centre concerned people living on the streets

c) Nine out of ten people are concerned about the crisis

d) Ninety percent of people believe they are protected from these infections

19) What does Dr. Jeffrey Duchin think?

a) The infections are surprising b) There are insufficient washing facilities

c) Shigellosis and trench fever have disastrous consequences

d) More houses should be built for the homeless

20) What does the sixth paragraph help us to understand?

a) The conditions in New York shelters are worse than those in Los Angeles

b) Tuberculosis infections could be due to poor sewage treatment

c) Homeless people are more susceptible to these diseases for a number of reasons

d) The pathology of these diseases has not changed since medieval times

21) What problem does Karen Mitchell have?

a) She has a chronic cough

b) She lost her job in pharmaceutical sales

c) She has to go to a new shelter

d) She has tuberculosis

22) In the final paragraph, what else needs to be done?

a) A Install more portable toilets and hand-washing stations

b) B Prevent more diseases

c) C Give free health care to homeless people

d) D Give assistance to people who want medical help or an inexpensive place to live.

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