Contents

LISTENING PRACTICE.............................................................................................................................1
PATIENT APPOINMENT.......................................................................................................................1
TEMPORARY PATIENT RECORD FORM................................................................................................2
PATIENT RECORD...............................................................................................................................3
SHORELAND HEALTH CENTER............................................................................................................4
TOTAL HEALTH CLINIC........................................................................................................................5
STUDENT HEALTH CENTRE MEDICAL RECORD...................................................................................6
OAKHAM SURGERY NEW PATIENT FORM..........................................................................................7
MEDICAL ADVICE...............................................................................................................................8
ONLINE MEDICAL...............................................................................................................................9
HEALTHY HEARING MEDICAL CLINIC & SURGERY.............................................................................10
BLOOD DONATION...........................................................................................................................11
CANCER TREATMENT.......................................................................................................................12
COSMETIC SURGERY........................................................................................................................13
HUMAN LONGEVITY RESEARCH.......................................................................................................14
CH3_HT1 -10....................................................................................................................................16
THE INFLUENCE OF CHILDREN ON ADULT DIET................................................................................17
READING: BASIC – INTERMEDIATE.......................................................................................................18
X- RAY OVERVIEW............................................................................................................................18
THE MEDICINE.................................................................................................................................19
DOCTOR IN THE USA........................................................................................................................20
BORODINE INFORMATION LEAFLET.................................................................................................21
CAUSTON HEALTH CENTRE..............................................................................................................23
BENTLEY HOSPITAL CATERING SERVICE...........................................................................................25
WHAT TO DO BEFORE AN OPERATION IN HOSPITAL........................................................................27
MENTAL AND PHYSICAL WELLBEING...............................................................................................28
WESTLEY GENERAL HOSPITAL..........................................................................................................31
GUIDE FOR PATIENTS.......................................................................................................................31
THE TRAGEDY OF DEMENTIA...........................................................................................................32
DO PLACEBOS HAVE A PLACE IN MEDICINE?...................................................................................34
CARIES SOLUTIONS..........................................................................................................................35
DENTIST REQUIREMENTS: WHAT IT TAKES TO BECOME A DENTIST.................................................36
POST-TRAUMATIC STRESS DISORDER...............................................................................................38
ANTIBIOTIC RESISTANCE ON THE RISE.............................................................................................40
DOES YAWNING HAVE A FUNCTION?...............................................................................................41
GENE THERAPY: A REVOLUTIONARY TREATMENT............................................................................42
THE UNSTOPPABLE RISE OF BURGER AND FRIES..............................................................................44
THE GROWING GLOBAL THREAT OF ANTIBIOTIC RESISTANCE..........................................................47
 SAMPLE GROUP ASSIGNMENT:........................................................................................................50
RECEDING GUMS.............................................................................................................................50
READING: ADVANCED..........................................................................................................................53
DOCTORING SALES...........................................................................................................................53
THE SEARCH FOR THE ANTI-AGING PILL...........................................................................................56
THE RISKS OF CIGARETTE SMOKE....................................................................................................60
CHANGING RULES FOR HEALTH TREATMENT...................................................................................64
 LISTENING PRACTICE

PATIENT APPOINMENT
Mr Jones wants an appointment with the doctor because he needs a (0) ……………………

1. Mr. Johns moved to Los Angeles

A. two weeks ago

B. three days ago

C. two days ago

2. When does Mr Johns have to go to his office? ……………………

3. Mr Jones works for a(an)

A. insurance company

B. medical company

C. real estate company

Mr Jones’ appointment with the doctor is at (4) ……………a.m on (5) ……………

Three medical tests that the insurance company requires Mr Jones to have

(6) …………………………

(7) …………………………

(8) …………………………

9. What is Mr Jones’ home telephone number, including the area code? ……………………..

10. What is the secretary’s first name? …………………………

 TEMPORARY PATIENT RECORD FORM
Write NO MORE THAN THREE WORDS for each answer.

PERSONAL DETAIL
Name Peter Smith
Address (1)………………………………………………………………..
Suburb (2) ……………………………………………………………….
Phone number (3) ……………………………………………………………….
DETAILS OF INJURY
Sport Tennis
Type of Injury Sprained (4) ……………………………………………………
Date of Injury (5) ……………………………………………………………….
PREVIOUS TREATMENT AND CURRENT PROBLEM
The private doctor of the patient suggested treatment with (6) …………………………
But the patient is still unable to (7) …………………………
He is also experiencing pain in his (8) ………………………… at night, which is affecting his sleep
ADVICE GIVEN Stop using the (9) …………………………
Do regular (10) ………………………… at home.
 PATIENT RECORD
Write NO MORE THAN THREE WORDS AND/OR A NUMBER for each answer.

Time of appointment: 10:00 am

Given names: Simon (1) …………………………

Family name: Lee

Date of birth: (2) …………………………. 1989

Address: (3)…………………………Adams Terrace, Wellington

Phone number: 0211558809

Name of insurance company: (4)…………………………

Date of last eye test: (5)…………………………

Patient’s observations: Problems seeing (6)…………………………

Write NO MORE THAN THREE WORDS for each answer.

(7) When must Simon wear his glasses? ………………………………………………………….

(8) What type of glasses are the least expensive? ……………………………………………….

(9) What is good about the glasses Simon chooses? ……………………………………………

(10) How does Simon decide to pay?.......................................................................................

 SHORELANE HEALTH CENTER
Write NO MORE THAN TWO WORDS AND/OR A NUMBER for each answer.

Name of centre Doctor’s name Advantage

The Harvey Clinic Dr. Green Especially good with (1)…………
The (2)……….. health practice Dr. Fuller Offers (3)…….appointments
The Shore Lane Health Centre Dr. (4)…………………

Questions 5-6

Which TWO of the following are offered free of charge at Shore Lane Health Centre?

A. acupuncture

B. employment medicals

C. sports injury therapy

D. travel advice

E. vaccinations

Write NO MORE THAN TWO WORDS AND/OR A NUMBER for each answer

Talks for patients at Shore Lane Health Centre

Subject of talk Date/Time Location Notes

Giving up smoking 25th February at 7pm Room 4 Useful for people with asthma or (7)
………....problems
Healthy eating 1st March at 5 pm The (8)…………. anyone welcome
(shore lane)
Avoiding injuries 9th March at Room 6 For all (10)……………..
during exercise (9)…………….
 TOTAL HEALTH CLINIC
Write ONE WORD AND/OR A NUMBER for each answer.

PERSONAL INFORMATION
Name Julie Anne Garcia
Contact phone (1)…………………
Date of birth (2)…………………, 1992
Occupation works as a (3)………………….
Insurance company (4)…………………. Life Insurance
DETAILS OF PROBLEM
Type of problem pain in her left (5)…………………..
When it began (6)…………………. Ago
Action already taken has taken painkillers and applied ice
OTHER INFORMATION
Sports played belongs to a (7)…………………. club
goes (8)…………………. regularly
Medical history injured her (9)………………… last year
no allergies
no regular medication apart from (10)………………..
 STUDENT HEALTH CENTRE MEDICAL RECORD
Write NO MORE THAN THREE WORDS AND/OR A NUMBER for each answer.

Patients name Martin Hansen

Faculty of (1) …………………………
Address 13, (2) ………………………… Street, Perth
Telephone (3) …………………………
Date of Birth 15th June 1986
Serious illness/ accident (4) …………………………
Operations (5) …………………………
Allergies (6) …………………………

7. Why is Martin visiting the doctor?

A. He suffers from headaches.
B. He suffers from nausea.
C. He has an infection.
8. How many hours does Martin usually sleep each night?
A . Less than eight.
B. Between eight and nine.
C. More than nine.
9. Which of these describes Martin’s problem?
A. It’s continuous and constant.
B. It’s worse during the daytime.
C. It’s worse in the evening and at night.
10. Which TWO of these things does the doctor suggest Martin should do?
A . change his diet
B. has his eyes tested
C. sleep more
D. take more exercise
E. take some medicine
 OAKHAM SURGERY NEW PATIENT FORM
Write ONLY ONE WORD OR A NUMBER for each answer.

Patient’s Road Dawson Road

Full name Mike (1) …………………………
Wife’s first name Janet
Children’s first names (2) …………………………
Address 52 Dawson Road (3) …………………… Melbourne
Health Card Number (4) ……………………
Wife’s Health Card Number will give later
Preferred doctor selected (5) …………………… White

6. When is Mike’s wife’s first appointment?

A. Friday 21st at 2.00 pm.

B. Friday 21st at 2.30 pm.

C. Friday 21st at 3.30 pm.

7. What is the surgery’s phone number?

A. 7253 9819 B. 7253 9829 C. 7523 9829

8. What is the name of the girl with whom Mike is speaking at the surgery?

A. Rachel B. Elizabeth C. Angela

9. What’s the night doctor’s mobile number?

A. 0506 759 3856

B. 0506 759 3857

C. 0506 758 3856

10. Which of the following does the surgery NOT make a charge for?

A. Travel vaccinations

B. Consultations

C. Insurance reports
 MEDICAL ADVICE
https://www.esl-lab.com/intermediate/medical-advice/

1. What is the man's name?

A. Randall
B. Ronald
C. Russell

2. From the conversation, how did the man probably find out about Dr. Carter?
A. He saw the office on his way home.
B. A friend referred him to the office.
C. He found the number in the phone book.

3. When does the man have his appointment?

A. Wednesday
B. Thursday
C. Tuesday

4. The man injured his ankle when ______.

A. a car hit him
B. stepped in a hole
C. fell from a ladder

5. The receptionist suggests that the man _____.

A. come into the office
B. put some ice on it
C. take a few days off work
 ONLINE MEDICAL
https://www.esl-lab.com/intermediate/online-medical/

1. James thinks that he has ____.

A. a cold
B. a stomachache
C. the flu

2. The woman thinks that James has a virus because ___

A. he has a high fever
B. his skin is a different color
C. his eyes are red

3. Where did the woman find information on this virus?

A. on a Web site
B. in a medical journal
C. on a medical podcast

4. James doesn't believe the information because it __.

A. doesn't come from a qualified doctor
B. is somewhat outdated and old
C. doesn't deal with his symptoms

5. According to the woman, James only has ______ to live.

A. a little over a month
B. about a week
C. a few days
 HEALTHY HEARING MEDICAL CLINIC & SURGERY
1. How many patients does the hospital consult every year?
A. 3,000.
B. 5,000.
C. 11,000.
2. When can patients meet the female doctor?
A. On weekday mornings.
B. Three days a week.
C. Only on Mondays and Fridays.
3. Who is the expert on treating hearing loss?
A. Mr. Roberts.
B. Mr Green.
C. Mr. Edwards.
4. Where are patients recommended to buy their medicine?
A. The supermarket in the town.
B. Pharmacies nearby the city centre.
C. The health care's pharmacy.
5. What will the patients be asked about whether they are willing to do?
A. Letting one student attend the consultation.
B. Asking postgraduate students to do treatment.
C. Meeting students in group discussion.

Write the correct letter, A-H (https://ielts-up.com/listening/ielts-listening-sample-14.2.html)

 BLOOD DONATION
https://www.esl-lab.com/academic-english/blood-donations/

1. About how many blood donations are needed every day in the United States?
A. 14,000
B. 40,000
C. 24,000

2. Approximately _________ people donate blood every year.

A. 9,200,000
B. 920,000
C. 92,000

3. According to the announcement, some people do not donate blood because ____.
A. they are afraid of the process
B. it isn't always convenient to schedule a time
C. they are concerned about their privacy

4. Which step for donating blood was NOT mentioned in the recording?
A. signing up for a time
B. eating food before you donate
C. reviewing your medical history

5. You can donate blood every ______ days.

A. 56
B. 66
C. 76
 CANCER TREATMENT
https://www.esl-lab.com/academic-english/cancer-treatment/

1. The man felt ______ when he found out about his cancer.
A. anger
B. shock
C. self-pity

2. The man _____ after he learned of his illness.

A. researched cancer treatments
B. underwent immediate surgery
C. retired from his job

3. After several months with the disease, the man's main source of strength was his
_____.
A. his belief in God
B. his family and friends
C. his doctors' encouragement

4. ________ was responsible for helping the man with his medications at home.
A. Family
B. His wife
C. A hospice worker

5. From this story, we can learn that _____.

A. we can be strengthened by challenges
B. families are the best support systems
C. all people must prepare for death
 COSMETIC SURGERY
https://www.esl-lab.com/academic-english/cosmetic-surgery/

1. An example of reconstructive surgery is _____.

A. a child involved in an accident
B. a man desiring to change his nose
C. a woman wanting to reshape her stomach

2. A personal with a physical deformity might _____.

A. lack self-worth
B. have fewer educational opportunities
C. not be able to find work

3. Volunteers also provide _____ in other countries.

A. physical therapy
B. fund-raising activities
C. local training

4. By providing services, volunteers often ____.

A. establish connections for future research
B. give doctors and nurses valuable in-field training
C. develop a deeper understanding of others

5. People can also help by ____.

A. adopting unwanted children
B. making financial contributions
C. educatinf themselves
 HUMAN LONGEVITY RESEARCH
CH2_19-22

Nature Factors

 scientists searching for longevity gene

- discovered protein that may reduce the speed of the (1) ...................... process

- critics find study defects: longer lives for humans are not necessarily indicated

from a molecular-level (2) ......................

Nurture Factors

 scientists found behavioural factors

 80-year study on longevity tracked environmental and behavioural factors of (3)
………………..subjects

- personality and relationships can help estimate the length of life

- longer lifespan for careful and determined subjects

- longer lifespan for those who are (4) ............. ..

CH2_HT11 -20

Questions 1-5: Choose the correct letter, A, B, or C.

1. Which topics does the speaker say he will talk about first?

A. how to limit the dioxins we consume

B. the origin and effects of dioxins

C. why people in the US don ' t know about dioxins

2. The ' Dirty Dozen' is a group of chemicals which is very

A. dangerous to the environment.

B. instrumental in harming food production.

C. common in nature.

3. Dioxins can be created by a number of human activities including

A. the use of chemical pesticides on farms.

B. the burning of trash.

C. the burying garbage.

4. Most of human exposure to dioxins

A. is from the food they consume

B. comes from contaminated soil.

C. results from handling pesticides and herbicides

5. High levels of dioxins in poultry

A. were traced back to Belgium

B. were caused by the food given to animals

C. were the result of hazardous waste

Write ONE WORD ONLY for each answer.

DIOXINS

Exposure to Dioxins:

• 6 ............................ function s can be impacted by short-term e xposure

• Long-term exposure can damage the 7 ............................. system and

reproductive functions

• Study revealed that a group exposed to dioxins from a factory had diabetes

rates higher than the 8 ... ...................... .... ...... a v erage

• Can lead to heart problems later in life

How to reduce exposure:

• Meat and 9 .... ........ should be consumed in smaller quantities

• Con sume less fish from certain areas

• A void contact with toxic chemical s produced by factories

• 10 ......... ......... can stop the creation of dioxins through restrictions

 CH3_HT1 -10
Questions 1-7: Write ONE WORD AND/OR A NUMBER for each answer.

World Health Organization

Global Food Safety Standards

STANDARDS DETAILS
First standard  Restaurants must follow updated sanitation.
Prevent human, pet, and pest  Restaurant workers must stick to 1 ...................... to
and extermination standards. avoid bacterial contamination of food.
Second standard  E-coli and salmonella are some of the most harmful
Ensure there's a 2 ............. bacteria.
between uncooked and  Any establishment storing food constantly
cooked food evaluates its storage standards
Third standard  Dr Dawen Sun found that most food- borne bacteria
Cook food at proper times  3 ...........................at a temperature of 60 degrees
and temperatures  Bacteria growth in animal products kept in 'danger
zone' will 4 ................. after 20 minutes.
Fourth standard  USDA - food in 30+ degrees temperatures should be
Store food at appropriate stored for one hour or less.
temperature  Industrial refrigerators should go through 5 ……......
twice each year.
Fifth standard • 6 …........... system designs were greatly improved.
Use safe and drinkable water • The water quality is 7 .................. better than in 2014

Questions 8-10

Choose THREE letters, A-G.

8-10. Which THREE food standards does the UK need to work on more?

A. Standard of service in restaurants

B. Sh ipping food safely to other destinations

C. Providing information for diners with restricted diets

D. Informing customers of the ingredients of food

E. Listing of the specific ingredient amounts

F. Providing a calorie count for menu items

G. Reducing amounts of fat and sugar in foods

 THE INFLUENCE OF CHILDREN ON ADULT DIET
Write NO MORE THAN TWO WORDS for each answer.

Background

Obesity - mainly caused by bad eating habits and lack of exercise

National survey conclusions:

 food consumption rose between 1971 and 2000

 Americans in general eat above the recommended amounts
 the age group that get most fat is 1................

Family members living together show 2………………levels of fat in their diet.

Aims of present study: to show whether children affect adult diet

Methods & procedures

Who?

 Adults aged 17-65 with children under 17

 Other variables: age, education, race, 3………..and whether born overseas
 4……... held at Mobile Examination Centres

Results

Adults living with children are more likey to

 eat more fat

 eat convenience food
 5………….

Reasons

 Parents have little 6……….

 Children's preference for certain foods
 Inconvenience of making separate meals

Limitations of study

 The study did not consider the effects of:

 the 7……… of children in each family
 the 8........... between the adults and children
 Influence may decrease with 9............

Conclusions and recommendations

 More research needed into above areas

 Research needed into how our 10………………affect our diet
 READING: BASIC – INTERMEDIATE

X- RAY OVERVIEW
X-ray technology is used to examine many parts of the body.

An X-ray is a quick, painless test that produces images of the structures inside your body —
particularly your bones. X-ray beams pass through your body, and they are absorbed in different
amounts depending on the density of the material they pass through. Dense materials, such as
bone and metal, show up as white on X-rays. The air in your lungs shows up as black. Fat and
muscle appear as shades of gray.

For some types of X-ray tests, a contrast medium — such as iodine or barium — is introduced into
your body to provide greater detail on the images.

Bones and teeth

• Fractures and infections: In most cases, fractures and infections in bones and teeth show up
clearly on X-rays.

• Arthritis: X-rays of your joints can reveal evidence of arthritis. X-rays taken over the years
can help your doctor determine if your arthritis is worsening.

• Dental decay: Dentists use X-rays to check for cavities in your teeth.

• Osteoporosis: Special types of X-ray tests can measure your bone density.

• Bone cancer: X-rays can reveal bone tumors.

Chest

• Lung infections or conditions. Evidence of pneumonia, tuberculosis or lung cancer can show
up on chest X-rays.

• Breast cancer. Mammography is a special type of X-ray test used to examine breast tissue.

• Enlarged heart. This sign of congestive heart failure shows up clearly on X-rays.

• Blocked blood vessels. Injecting a contrast material that contains iodine can help highlight
sections of your circulatory system to make them visible on X-rays.

Abdomen

• Digestive tract problems. Barium, a contrast medium delivered in a drink or an enema, can
help reveal problems in your digestive system.

• Swallowed items. If your child has swallowed something such as a key or a coin, an X-ray
can show the location of that object.
Do the following statements agree with the information given in the Reading Passage?

YES if the statement agrees with the writer

NO if the statement does not agree with the writer

NOT GIVEN if the information is not given in the passage

1. Patients may feel little painful when they are doing an X-ray examination.

2. Different parts of the body are seen in different colors through an X-ray scan.

3. Iodine is more favorable than barium as a catalyst for enhancing X-ray images.

4. The speed of arthritis can be detected by using X-ray

5. Pneumonia is the most popular lung infections based on the number of X-ray examinations.

THE MEDICINE

 This medicine must be taken as directed.

 Before using, shake the bottle.
 Dose: 50ml to be taken twice daily after the midday and evening meals.

Instructions:

 Do not take this medicine on an empty stomach or immediately before lying down.
 If any of the following occur, discontinue taking the medicine and contact your doctor:
dizziness, vomiting, blurred vision.
 This medicine is not available without a prescription and is not suitable for children under 5
years.
 Once you have begun to take this medicine you must continue to take it until the bottle is
empty, unless advised otherwise by your doctor.
 Only one course of this medicine should be taken in a period of six months.
 Expiry date: 16 February 2004.

Do the following statements agree with the information given in the Reading Passage?
YES if the statement agrees with the writer
NO if the statement does not agree with the writer
NOT GIVEN if the information is not given in the passage
 1. You must shake the bottle before you take the medicine.

2. You should lie down after you have taken the medicine.

3. You must stop taking the medicine if your eyesight is affected.

4. You must stop taking the medicine when you feel better.

5. This medicine is suitable for a person of any age.

DOCTOR IN THE USA

Most young physicians in the United States today choose to specialize. To become a
specialist, a doctor must first receive training in an accredited program called a residency. This
training takes from three to seven years, depending upon the field of specialization. Residency
training takes place in a hospital or ambulatory care setting, where the specialist-in-training (called
a resident) cares for patients under supervision of experienced teacher-specialists. After
completing the training, specialists may then take an examination given by the specialty board they
are applying to. Those who pass are called board- certified specialists. In the United States, there
are 24 specialties recognized by the American Board of Medical Specialties (ABMS) and the
American Medical Association (AMA). Some specialty boards require physicians to practice in the
specialty for a year or more before they may apply to become board certified.

Some specialists later choose to subspecialize, which generally requires an additional

two or more years of training. Two fields in which there are a number of subspecialties are internal
medicine and pediatrics. General internists provide nonsurgical care for adolescents and adults.
Internists may become subspecialists in thirteen different areas. Among these are cardio-vascular
medicine, gastroenterology, geriatric medicine (treatment of the elderly), hematology (diseases of
the blood, spleen, and lymph glands), infectious diseases, nephrology (diseases of the kidney),
pulmonary diseases, rheumatology (diseases of the joints, muscles, bones, and tendons), medical
oncology (cancer), and allergy and immunology. Pediatricians (who treat children from birth to
young adulthood) can subspecialize in seven different areas including cardiology, endocrinology,
hematology-oncology, and neo-natal-perinatal medicine.

When choosing a specialty, physicians must consider many factors. One is, of course,
which which types of branches of medicine interests them most. Another practical consideration is
need specialists are in short supply in the area where the physician plans to practice. But there are
many other factors to consider. Physicians should choose fields that mesh best with their own
abilities and talents. The first decision is whether one wants a surgical or a medical (nonsurgical)
specialty. Internists and other medical specialists must be good diagnosticians, which requires the
mental skills of a detective. Suppose a patient complains of frequent headaches. The cause might
be anxiety or stress, sinus congestion, vision problems, a virus, a circulatory problem, a tumor, or
some other condition. The physician treating this patient needs to know what questions to ask and
what tests to order to find the cause.

Read the following passage and mark the statement T if it is True and F if it is False

1. It takes a doctor three years of training to become a specialist.

2. A doctor who is in training to become a specialist is called a resident.

3. A board-certified specialist someone who takes an examination given by a specialty board.

4. A physician needs to practice up to a year in the specialty before applying to become board
certified.

5. Nephrology is a subspecialty of internal medicine.

6. Pulmonary diseases are diseases of the joints, muscles, bones and tendons.

7. Pediatricians can subspecialize in neo-natal-perinatal medicine.

8. Interest and need are among the most important factors to be considered when choosing a
specialty.

9. The mental skills of a detective are necessary for a good diagnostician.

10. Headaches can cause vision problems.

BORODINE INFORMATION LEAFLET

The name of your medicine is Borodine tablets.

 WHAT ARE BORODINE TABLETS USED FOR?

Borodine tablets are used to help relieve hay fever and conditions due to allergies, in particular,
skin reactions and a runny nose.

It is not recommended that Borodine tablets are given to children under 12 years of age or
pregnant or breastfeeding women.

 BEFORE YOU TAKE BORODINE TABLETS

In some circumstances, it is very important not to take Borodine tablets. If you ignore these
instructions, this medicine could affect your heart rhythm.

Are you taking oral medicines for fungal infections?

Have you suffered a reaction to medicines containing Borodine before?

Do you suffer from any liver, kidney or heart disease?

If the answer to any of these questions is YES, do not take Borodine tablets before consulting your
doctor.

 AFTER TAKING BORODINE TABLETS

Borodine tablets, like many other medicines, may cause side-effects in some people.

If you faint, stop taking Borodine tablets and tell your doctor immediately.

In addition Borodine tablets may cause problems with your vision, hair loss, depression or
confusion, yellowing of your skin or your eyes.

If you have these effects whilst taking Borodine tablets tell your doctor immediately.

Other side-effects are dizziness or headaches, and indigestion or stomach ache. However, these
effects are often mild and usually wear off after a few days' treatment. If they last for more than a
few days, tell your doctor.

Look at the patient information leaflet below. Match each of the following sentences with
TWO possible endings A-M from the box below.

1. Borodine table should not be given to ......

2. Borodine tablets might be used to treat......
3. You must ask your doctor before taking Borodine tablets if you are already being treated for .....
4. You do not need to consult your doctor immediately if Borodine tablets give you ......
5. You must consult your doctor at once if you find Borodine tablets cause......

Possible Endings

A. children under 12 years of age.

B. a headache.

C. an uncomfortable feeling in your stomach.

D. symptoms similar to a cold.

E. a change in your skin colour.

F. anything treated by a prescription medicine.

G. a kidney complaint.

H. a whitening of the eyes.

I. sore or broken skin.

J. a fungal infection.

K. a feeling of sadness.

L. shortness of breath.

M. a woman expecting a child

CAUSTON HEALTH CENTRE

A. Appointments:

Please telephone 826969 (8.30am - 5.00pm: Mon - Fri). We suggest that you try to see the same
doctor whenever possible because it is helpful for both you and your doctor to know each other
well. We try hard to keep our appointments running to time, and ask you to be punctual to help us
achieve this; if you cannot keep an appointment, please phone in and let us know as soon as
possible so that it can be used for someone else. Please try to avoid evening appointments if
possible. Each appointment is for one person only. Please ask for a longer appointment if you need
more time.

B. Weekends and Nights:

Please telephone 823307 and a recorded message will give you the number of the doctor from the
Centre on duty. Please remember this is in addition to our normal working day. Urgent calls only
please. A Saturday morning emergency surgery is available between 9.30am and 10.00am. Please
telephone for home visits before 10.00am at weekends.

C. Centre Nurses:

Liz Stuart, Martina Scott and Helen Stranger are available daily by appointment to help you with
dressings, ear syringing, children's immunisations, removal of stitches and blood tests. They will
also advise on foreign travel, and can administer various injections and blood pressure checks. For
any over 75s unable to attend the clinic, Helen Stranger will make a home visit. AII three Centre
Nurses are available during normal working hours to carry out health checks on patients who have
been on doctors' lists for 3 years.

D. New Patients:
Within 3 months of registering with the Centre, new patients on regular medication are invited to
attend a health check with their doctor. Other patients can arrange to be seen by one of the Centre
Nurses.

E. Services Not Covered:

Some services are not covered by the Centre e.g. private certificates, insurance, driving and sports
medicals, passport signatures, school medicals and prescriptions for foreign travel. There are
recommended fees for these set by the National Medical Association. Please ask at reception.

F. Receptionists:

Our receptionists provide your primary point of contact-they are all very experienced and have a lot
of basic information at their fingertips. They will be able to answer many of your initial queries and
also act as a link with the rest of the team. They may request brief details of your symptoms or
illness - this enables the doctors to assess the degree of urgency.

G. Change of Address:

Please remember to let us know if you decide to relocate. It is also useful for us to have a record of
your telephone number.

Questions 1-4: Which paragraph contains the following information?

1. what to do if you need help outside normal working hours

2. who to speak to first for general information

3. what happens when you register with the Centre

4. what to do if you need to cancel a doctor's appointment

Questions 5-9

TRUE if the statement agrees with the text

FALSE if the statement contradicts the text

NOT GIVEN if no information is given about it

5. You must always see the same doctor if you visit the Centre.

6. If you want a repeat prescription you must make an appointment.

7. Helen Stranger is the Head Nurse.

8. It is possible that receptionists will ask you to explain your problem.

9. You should give the Health Centre your new contact details if you move house.

BENTLEY HOSPITAL CATERING SERVICE

TO ALL PERMANENT AND TEMPORARY MEMBERS OF STAFF

IMPORTANT INFORMATION

Meal Breaks - (minimum company guidelines)

HOURS WORKED BREAK TO BE TAKEN

0-4 hrs nil
4-6 hrs 15 mins
6-8 hrs 30 mins
8-12 hrs 60 mins (taken as 2 x 30 mins)
12-24 hrs 75 mins (taken as 2 x 30 mins + 1 x 15 mins)

Your section staffing board will show the times when these breaks are to be taken.

Please note

It is your responsibility to check that the total break time shown on the staffing sheets accurately
reflects the breaks that you take. Any discrepancies should be raised with your Staff Co-ordinator
immediately.

SPECIAL REQUIREMENTS - FOOD HANDLERS

Food handlers are those concerned with preparing and serving unwrapped food. Food handlers
should report any instance of sickness, diarrhoea and/or stomach upset experienced either while at
work or during a holiday to a member of the Personnel Management team. Any infections of ear,
nose, throat, mouth, chest or skin should also be reported to a member of the Personnel
Management team. Food handlers need to have an annual dental examination by the company
dentist. Alternatively, a current certificate of dental fitness may be produced from their own dentist.
This applies to all permanent staff who handle food.

Complete each sentence with the correct ending, A-J, below.

10. Temporary employees only working 3 hours should

11. Employees who work 11 hours should

12. To find out when to have their breaks, employees should

13. Employees working with food must

14. Food handlers who have been ill should

A. talk to a staff co-ordinator.

B. have two thirty-minute breaks.

C. not take any breaks for meals.

D. pay for any meals they have.

E. get a single one-hour break.

F. look at the section staffing board.

G. lose pay for their break times.

H. tell a member of the Personnel Management team.

I. have an annual dental examination.

J. consult their doctor.

 WHAT TO DO BEFORE AN OPERATION IN
HOSPITAL
In the days leading up to your surgery, you’ll need to think about how you’ll get to the hospital and
back again. You probably won’t be well enough to drive, so you may want to arrange transport or
ask a friend or relative to help. Make sure you give your family and friends plenty of notice about
your operation, so that if necessary, they can take time off work to be with you. Check your
hospital’s policy on visiting times and let your family and friends know. When preparing your things
for your stay, remember to bring your appointment card with you too.
Pre-operative assessment
At some hospitals, you’ll be asked to attend a pre-operative assessment, which may be an
appointment with a nurse or doctor, a telephone assessment or an email assessment. You’ll be
asked questions about your health, your medical history and your home circumstances. If the
assessment involves a visit to the hospital, some tests may be carried out, including a blood test.
This assessment will usually happen one or more days before your operation. Make sure you
know the results of any previous tests. You’ll be given clear information on:
• if you need to stop eating and drinking in the hours before your operation (see below)
• whether you should cease taking your usual medications before going into hospital
• what to bring with you into hospital
• whether you’ll need to stay in hospital overnight and, if so, for how long
The importance of fasting
If your doctor has instructed you to fast before the operation, it’s really important that you don’t eat
or drink anything — this includes light snacks, sweets and water. You need an empty stomach
during surgery, so you don’t vomit while you’re under anaesthetic.
Hygiene
You’ll need to remove all make-up and nail polish before your operation, as the doctors will need
to see your skin and nails to make sure your blood circulation is healthy. This can also help to
reduce the chances of unwanted bacteria being brought into the hospital.

Write NO MORE THAN TWO WORDS from the text for each answer.
1. It’s important to include your…………………when packing your things for your time in hospital.
2. A pre-operative assessment may be conducted face to face, by phone or by…………….
3. Part of a pre-operative assessment might include a test of a patient’s………………..
4. Patients might be told to stop their………………..in their pre-operative assessment.
5. Patients might suffer negative effects if they eat or drink before their pre-operative………………
is administered.
6. Removing all cosmetics allows doctors to properly assess a patient’s……………………
 MENTAL AND PHYSICAL WELLBEING
Five activities that can protect your mental and physical health as you age

A No one is immune to developing chronic illnesses such as heart disease, cancer or arthritis
as they get older. But research shows social activities, like joining clubs, interest groups or
volunteering, are linked to better mental and physical health and a longer lifespan. Our own recent
research found that the more that people participated in social activities, the less risk they had of
developing or accumulating chronic conditions. We looked at people aged 50 and older from 12
European countries over a five year period and studied how volunteering, education, joining a club
or being involved in religious or political groups impacted their likelihood of developing major
chronic illnesses.

We found that weekly participation in social activities reduced the risk of developing a chronic
condition by 8% compared to no participation, and reduced the risk of developing two or more
chronic conditions by 22%. Even if you’re busy, our findings suggest that just a few hours spent on
a social activity every week can protect your health. Not only are social activities important for
keeping physically active, engaging in activities with other people is shown to benefit your mental
wellbeing, which in turn further protects your physical health. With that in mind, there’s a wealth of
research that shows doing just one of these five activities regularly will provide benefits.

B Taking time to be inspired by new things is good for our health. Studies show that people who
read books live longer, and bilingual people have better cognitive health. Pursuing new knowledge
or learning new skills is known to promote wellbeing and memory function. Activities like attending
an art or music class are associated with enhanced brain health, as they improve the
communication between different brain regions. They can also improve psychological resilience,
meaning that they can improve people’s ability to cope better and persevere through stressful or
challenging situations.

People who have made a habit of learning throughout their lifetime generally have better physical
and mental health, including reduced risk for heart diseases and obesity, healthier habits (such as
good nutrition, exercise, and not smoking), better wellbeing and cognition, and a stronger sense of
purpose in life.

C Research shows joining a handball or football team has multiple health benefits, such as lower
blood pressure, better heart rate, lower fat mass and musculoskeletal fitness. People are also
more motivated and have better wellbeing. Even less common activities like rock climbing
reportedly ward off symptoms of depression, while hiking is shown to promote emotional health,
creativity, a sharp mind and healthier relationships. This might be because living in the moment
can be a healthy distraction from stress and worries. Physical activity might let someone
experience “flow”, the state of being completely absorbed, focused and involved in something.
During flow, people typically report deep enjoyment, creativity and happiness.

Even non-exercise group pastimes are beneficial. Mentally stimulating activities, such as card and
board games, videogames, needlework or crafts, have been shown to improve and sustain good
mental and cognitive health. Joining a choir not only protects physical and mental health,
enhances wellbeing and reduces loneliness, it also promotes lung health and reduces anxiety as a
result of controlled breathing practices. Group activities such as singing, knitting, painting, playing
board games or playing football have also been shown to increase social belonging and help
people bond.

D The old saying that it’s better to give than to receive might be true. Research shows that
spending time volunteering is associated with enhanced mental health, higher physical activity,
fewer functional limitations and lower risk of mortality.

We have previously shown that weekly volunteers are twice as likely to have optimal mental
health compared to non-volunteers. Other researchers have reported similar links to acts of
kindness in general. Volunteering can benefit mental health by providing a sense of meaning and
purpose, improving competence, self-esteem, solidarity and compassion, as well as opportunities
to connect with others.

E Being able to contribute to one’s community is also key to mental health. This is because
humans have an intrinsic need to both be connected with a community and have a role to play in
it. One way to do that is through political or civic group activity.

Community engagement is generally associated with better physical and mental health and
wellbeing, and some research even shows civic involvement at age 33 is protective against
cognitive impairment at age 50. This means that being active in a civic group is linked to sustained
cognitive health over 15 years.

F A large volume of research shows that religion and spirituality are, in general, beneficial to
mental health. These mental health benefits positively impact physical health and decrease the
risk of disease by improving immune function and lowering the stress response.

When becoming ill, many use their religious beliefs to cope with illness, which is important since
poor coping skills can lengthen hospital stays and increase patient mortality. Accordingly, some
evidence suggests that religious people tend to have better recovery when ill or having undergone
surgery. Also, attending religious services is associated with long life and better brain health, as
well as increased resilience against depression even for high-risk people.
No matter what activity you choose, all of them have three behavioural principles in common that
we have written about before, known as Act-Belong-Commit. Getting active, getting social, and
getting involved can help you maintain good mental and physical health in general and as you
age.

Choose the correct heading for each section from the list of headings below.

* Note – there are more headings than sections so not all the headings will be needed.

List of Headings

i How helping others can improve mental well-being.

ii Evidence that social interaction enhances both mental and physical health.

iii The recommendation to be active in nature.

iv The positive effects of attending a place of worship and belief in a higher power.

v The benefits of having a mental or physical activity to focus on.

vi The value of learning something new.

vii The importance of having a regular routine.

viii Community involvement before reaching middle age.

1. Section A

2. Section B

3. Section C

4. Section D

5. Section E

6. Section F
 WESTLEY GENERAL HOSPITAL
GUIDE FOR PATIENTS
When you come to hospital for a planned stay, please remember that space is limited. We also
advise you to bring an overnight bag even if you are only expecting to spend a day in hospital.

A Clothing

Please bring a selection of light clothing and personal belongings that may include: night clothes,
a track suit, a sweater or fleece, a bathrobe, slippers or socks, glasses, contact lenses, dentures,
a hearing aid, bottled drinks (plastic only), tissues, books and magazines, contact details of
friends, cash to purchase items during your stay.

B Toiletries

Please bring a selection with you including a shaving kit if you are male. The hospital also runs a
shop and trolley service from which extra items (additional toiletries, magazines, stamps,
newspapers etc.) can be purchased.

C Valuables

We strongly advise you not to bring any valuables with you as their security cannot be
guaranteed. A closet is provided for some personal items.

D Electrical appliances

We ask that you do not bring electrical appliances with you. TV, radio and payphones are
provided.

E Medicines

Please bring all your current medication with you, preferably in their original containers. On arrival
the nursing staff will ask about your history and allergies.

F Maternity

Please bring the appropriate baby clothes and feeding equipment. For further information, please
contact the Maternity Unit on 740648.

G What Not to Bring

Please do not bring any valuables (jewellery), personal computers, radios, TVs. The hospital
cannot be held responsible for the loss of any items during your stay. Please note that the hospital
does not allow the use of mobile telephones due to possible interference with patient monitoring
equipment.

H Smoking and Drinking Policy

Smoking and alcohol are strictly prohibited in Westley Hospital. Patients wishing to smoke must
do so outdoors. No alcohol is allowed on the premises.

I Visiting Hours

For details about when your friends and family can visit, see the list in your room or ward or check
our website.

In boxes 13 – 17 on your answer sheet write:

TRUE if the statement is true

FALSE if the statement is false

NOT GIVEN if the information is not given in the passage

13. Don’t bring any money to the hospital.

14. Radios can interfere with hospital electronic equipment.

15. Leave any false teeth at home.

16. You should pack a bag to stay for the night even if you intend only to be a day patient.

17. Telephone services are provided through coin or card operated telephones.

Which section best helps you with the following things that you want to know?

18. You are allergic to some antibiotics.

19. Your brother wants to know when to come and see you.

20. You want to buy something to read at the hospital.

BRIEF REPORT ON OBESITY IN THE UK

Choose NO MORE THAN THREE WORDS from the passage to complate the table

The rising problem of obesity has helped to make diabetes treatments the biggest drug bill in
primary care, with almost £600 million of medicines prescribed by doctors last year, according to
the NHS Information Centre.

Analysts said that young people contracting the condition, which is often associated with obesity,
were helping to push up costs as doctors tried to improve their long-term control of the disease
and prevent complications.
A total of 32.9 million diabetes drugs, costing £599.3 million, were prescribed in the past financial
year. In 2004-05 there were 24.8 million, costing £458 million. More than 90 per cent of the 2.4
million diabetics in England have type 2 diabetes, with the remainder suffering from type 1, the
insulin-dependent form of the disease. There are thought to be 500,000 undiagnosed cases of
diabetes.

While rates of type 1 have shown slight increases in recent years, type 2 has risen far more
rapidly - a trend linked to the increasing number of people who are overweight or obese. Almost
one in four adults in England is obese, with predictions that nine in ten will be overweight or obese
by 2050. Obesity costs the NHS £4.2 billion annually. This year the Government started a £375
million campaign aimed at preventing people from becoming overweight by encouraging them to
eat better and exercise more.

An NHS Information Centre spokeswoman who worked on the report, which was published
yesterday, said that diabetes was dominating the primary care drug bill as better monitoring
identified more sufferers and widely used medications for other conditions such as statins became
cheaper. She said that the data suggested a growing use of injectable insulin in type 2 diabetes
care, which was helping to push up costs.

Doctors agreed that more expensive long-acting insulin, which can cost about £30 per item, was
being used more often, as well as more expensive pills and other agents.

The report, an update of the centre's June publication Prescribing for Diabetes in England, shows
that the number of insulin items prescribed last year rose by 300,000 to 5.5 million, at a total cost
of £288.3 million. It marked an 8 per cent rise on the £267 million spent in the previous year.
However, while the number of anti-diabetic drugs, which are mostly in tablet form, also rose, the
cost dropped slightly to £168.1 million.

Type 2 is increasing. We are seeing it in younger people, and because it is a progressive disease,
people are needing an increasing number of interventions as time goes by," the spokeswoman
said, adding that long-acting insulins such as Glargine were now common. 'For people who are
struggling to control their type 2 diabetes it makes sense, but it is quite a big clinical change from
five or ten years ago."

Other anti-diabetic items, such as use of the subcutaneous injection exenatide, have also
increased and cost £14.3 million. Laurence Buckman, chairman of the British Medical
Association's general practice committee, said that he had observed a trend with drugs such as
exenatide, which costs £80 per item. He said that younger patients could start on cheaper tablets
such as metformin, which costs £3.70 per box, but were needing increasingly sophisticated
treatments to keep their condition in check.
'You are talking about an ever larger number of people getting a large range of drugs to reduce
long-term complications. Type 2 is a common chronic illness that is getting commoner. It's in
everyone's interest to treat people early and with the most effective drugs, and these are the more
expensive tablets and long-acting insulins,' he said.

Name of drugs Cost per items

Insulin
Exenatide
Metformin
Total for … Cost of medicine in million pounds
Diabetes last year
Diabetes 2004-2005
Insulin last year
Insulin 2 years ago

THE TRAGEDY OF DEMENTIA

Statistics reveal that approximately 35.6 million people worldwide are living with and, dementia, a
brain disorder that results in the progressive loss of cognitive ability and eventually, death. As the
risk of developing the condition doubles every half decade after the age of 65, society is growing
increasingly concerned about how we will care for our rapidly aging population.

Dementia causes the brain's neurons to it deteriorate over time, so those who have it experience
difficulty learning, reasoning, speaking, recalling and past experiences, and controlling their
emotional reactions. It is even very common for those with demantia to be unable to recognise
their family members. While this can obviously be an upseting experience for a son, daughter, or
spouse, the inability to place a most familiar face is most demoralising and frustrating for the
dementia sufferer. It is therefore unsurprising that severe anxiety goes hand in hand with dementia
and that this accompanying condition often exacerbates the disorder by causing fits of psychosis
and aggression.

Because dementia victims lose the ability to make sense of their thoughts and feelings their
behaviour becomes unpredictable. They may experience what are known as ‘catastrophic
reactions', which involve sudden emotional shifts to tears or anger upon finding themselves in
situations they cannot handle. To prevent them from wandering off aimlessly, attempting to drive a
vehicle, or forgetting to eat, they will usually require full-time care and supervision. This becomes
a necessity for people in the final stages of dementia, when they may also lose the ability to
control their movements or even digest food due to muscle deterioration. Frail and out of touch
with reality, dementia patients become very susceptible to illness at this point and often succumb
to accidents or common colds.

The burden of dementia sufferers on their family and caretakers is quite severe. The emotional toll
of slowly losing a family member or spouse notwithstanding, caretakers commonly experience
burnout from trying to cope with the confusion, irrationality, and sometimes abusive behaviour of
their loved ones. The financial fallout can be equally as devastating given the amount of time and
resources required to provide care to dementia sufferer. Hiring a fulltime nurse to administer
home-based care or arranging for the patient to be moved to an assisted-living facility or nursing
home is a major expense which a large portion of the population simply cannot afford.

It is clear that we are not yet equipped to handle the challenges of dementia. In addition to
developing more health and social services for sufferers and their families, governments are
strongly encouraged to increase the public's awareness of the condition. This way people will be
more conscious of the symptoms as they get older and know when it is time to seek help. With an
early diagnosis, symptoms can be controlled from the beginning, which can greatly prolong life.
Early diagnoses also give patients the opportunity to plan for their own long-term treatment and to
settle their affairs. Until a cure is found for this terrible affliction, resources that improve patients'
day-to-day lives and help them live their final days with dignity are vital.

Choose NO MORE THAN TWO WORDS AND/OR A NUMBER from the passage for each

1. After what age does the chance of developing dementia double every five years?

2. Which separate condition can make the symptoms of dementia worse?

3. What causes problems with motion and food digestion in the final stages of dementia?

DO PLACEBOS HAVE A PLACE IN MEDICINE?

A placebo is an imitation medicine that doctors sometimes administer to patients. Although they
contain no pharmacological substances, patients who are given placebos are often convinced that
these sugar pills possess the power to alleviate their symptoms or even cure them of their
illnesses. What is most remarkable is that sometimes, they do. This bafling psychological and
medical phenomenon is known as the placebo effect.

Some medical practitioners believe that the apparent efficacy of placebos lies in the simple act of
writing a prescription. Essentially, it is thought that patients assume their ailments can be
overcome if it is possible to prescribe medications for them. This view is substantiated by studies
indicating that a large percentage of those seeking medical treatment suffer from disorders that
the body is capable of healing itself. However, patients strongly think otherwise, and this attitude
makes them attribute getting better when they eventually do, solely to the medication they were
prescribed. This, coupled with the trust they have in their doctor's ability to treat them, is what
some say accounts for the positive performance of placebos.

Nevertheless, most experts strongly oppose medicating patients with placebos, suggesting the
practice violates the doctor-patient relationship. Medical ethics standards maintain that trust is
paramount and that doctors should be honest. However, some physicians are tempted to provide
misinformation or gloss over the truth because they believe doing so is in the patient's best
interests. For instance, a doctor may choose to present patients with a more optimistic picture of
possible outcomes in order to convince them to undergo treatments they might otherwise reject. It
is the hope that comes from believing it is still possible to be cured that can make all the difference
in the end.

Further studies report of some patients learning they have been given placebos instead of actual
drugs. In many cases, this causes patients to lose faith in their doctors, resulting in exacerbated
symptoms and their health taking a turn for the worse. Due to the possibility of malpractice suits,
the use of placebos in clinical practice has become increasingly uncommon. These days,
placebos are almost exclusively administere in research situations where the subjects are
informed that they may or may receive a placebo and told about all potential risks in advance. In
addition, policies areimplemented to ensure that informed consent is observed, thus aligning
standards medical research and practice with the need for further investigation into the so-called
placebo effect.

Choose ONE WORD ONLY from the passage for each answer

The Placebo Effect

How placebos work

• Some professionals think that a placebo's effectiveness could be due to a doctor

making a 24._____________

• Research shows that many patients asking for medicine will heal without it.

• A patient's 25.____________ makes them think any improvement they feel is due to
medicine.

The opinion of doctors

• Most 26._____________are against giving patients placebos.

• The honesty of doctors is considered ethically important.

• Doctors sometimes think it's in the patient's best 27._____________ not to tell the truth.

• The health of patients who find out they've been given placebos can become 28._________

Current usage

• Today, placebos are mostly used for 29.___________

CARIES SOLUTIONS
Regular checkups can identify cavities and other dental conditions before they cause troubling
symptoms and lead to more serious problems. The sooner you seek care, the better your chances
of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated
before it starts causing pain, you probably won't need extensive treatment.

Treatment of cavities depends on how severe they are and your particular situation. Treatment
options include:

Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your tooth's
enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride
treatments contain more fluoride than the amount found in tap water, toothpaste and mouth rinses.
Fluoride treatments may be liquid, gel, foam or varnish that's brushed onto your teeth or placed in
a small tray that fits over your teeth.

Fillings. Fillings, also called restorations, are the main treatment option when decay has
progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-colored
composite resins, porcelain or dental amalgam that is a combination of several materials.

Crowns. For extensive decay or weakened teeth, you may need a crown — a custom-fitted
covering that replaces your tooth's entire natural crown. Your dentist drills away all the decayed
area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high
strength porcelain, resin, porcelain fused to metal or other materials.

Root canals. When decay reaches the inner material of your tooth (pulp), you may need a root
canal. This is a treatment to repair and save a badly damaged or infected tooth instead of removing
it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any
infection. Then the pulp is replaced with a filling.
Tooth extractions. Some teeth become so severely decayed that they can't be restored and must
be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift. If possible,
consider getting a bridge or a dental implant to replace the missing tooth.

Use the correct form or a synonym of the words in the passage to complete these sentences

1. The amount of flouride in professional treatments is__________ than in daily oral products.
2. Restoration is applied when the development of cavities is _________ than the new detection.
3. In crown treament, the _________ of matierials could be moulded to form a new crown.
4. Because of the _________ condition, ________ teeth is the final step when other treatments
cannot be applied.

DENTIST REQUIREMENTS: WHAT IT TAKES TO

BECOME A DENTIST
The requirements to become a dentist are rigorous, ensuring a high academic achievement quality
and several years of practical education before seeing patients. We're highlighting the four main
steps all hopeful dentists must take to begin working in this well-regarded profession.

You probably know that medical doctors and lawyers need more years of schooling after their
undergraduate degrees. Dentists must also attend at least four years of additional school. Dentist
requirements extend beyond education, though. A dental student needs to pass several exams
before they get licensure. Some students will even complete more schooling to work as a
specialist.

In 2020, U.S. News and World Report ranked dentistry as the second-best career in the U.S. The
publication assesses the best jobs by looking at salary, work-life balance, and potential challenges.
The next four sections will highlight what a person has to go through before becoming a dentist and
the credentials to look for when researching your next dental health professional.

The Dental Admissions Test

The first step in considering a dental degree is determining the testing and prerequisites needed
during an undergraduate degree. Any college student thinking about becoming a dentist needs to
take the Dental Admissions Test (DAT). As the American Dental Association (ADA) notes, it's
typically recommended that students take the DAT at least a year before applying to dental school,
usually during their junior year of college.

Attending Dental School – Prerequisites and Degree Requirements

Along with their DAT scores, most students also need to have a good grade point average (GPA),
experience shadowing a dentist, and excellent recommendation letters. Although an applicant
doesn't need a science degree to enroll, they need some dentist education requirements from their
undergraduate classes. Most programs require at least eight hours of biology, chemistry, physical
science, organic chemistry, and English courses as an undergrad before applying.

Most dental schools are four-year programs. Schools either award a Doctor of Dental Surgery
(DDS) or a Doctor of Medicine in Dentistry (DMD). According to the ADA, the two degrees are the
same, meaning they involve the same coursework and practice methods. The only difference is the
name. Look for either degree when confirming your dentist received the proper education or when
researching programs for yourself!

Typically, the first two years of dental school focus on coursework. The second two years focus on
clinical training, as the American Dental Education Association (ADEA) points out. The exact
course of training for a dentist will vary slightly from school to school.

Passing Dental Licensure Exams

Once dental school is complete, a student needs to take and pass a series of examinations. The
ADA notes three critical requirements to licensure: an educational component, a written test, and a
clinical examination. Besides these three components, additional requirements for licensure vary
by state.

Considering a Dental Specialty and Extra Schooling

Did you know that 20% of dentists in the U.S. are specialists? They range from oral surgeons to
orthodontists to pediatric dentists. As noted above, becoming a specialist requires more training –
in some cases, as many as six extra years of education and clinical experience. Once a dentist has
completed dental school and all the necessary exams and potential postgraduate training, they are
ready to put their learnings into practice! They can set up an office as a private practice dentist,
teaching patients the benefits of daily oral care, diagnosing and treating cavities or other dental
problems, and generally helping patients have the healthiest mouths possible.

Although the road to becoming a dentist is a long one, it's well worth it for those who have a
passion for improving people's oral health. Everyone needs dental care, and thus, this profession is
in high demand and serves a worthy cause.

Write NO MORE THAN THREE WORDS from the passage to complete the paragraph below.

Taking the (1) ………………. is mandatory for all undergraduate students if they want to enroll in
dental school. It is recommend that they should do the test in their (2) …………….…. Besides good
academic background and dentistry experience, a/ an (3) …………..…… is also important to be
admited. Most of dental school offer (4) ……………. program, including first half of (5) …………..
knowledge before second-half clinical training. After finishing, students are recognized as (6)
………….., which are no (7)………….…. between them. However, they have to undergo (8)
……………, which is a 3-part examination and other extra (9)………….. to be certified by (10)
………… However, they are still not be considered as a/ an (11) ……..…… They have to earn more
(12)……..…..…. by spending further (13)…..………….of traning. Then, all the knowledge gained is
put into (14)………..…… They are able to open a/ an (15)….……….., introducing methods of oral
care and directly being responsible for (16)……..….….. dental diseases. Despite challenges and
hard-earning (17)….………….., being a dentist is (18)………..….. because it is the (19)
………………. occupation in the USA, as it provides attractive (20)…………… and work-life
balance.

POST-TRAUMATIC STRESS DISORDER

A Post-traumatic stress disorder is a clinical mental illness that was first observedin war
veterans. The condition results from trauma that is either life threatening, the cause of a serious
injury, or something that the affected person responded to with intense fear, helplessness or horror.
In the 1970s, in the aftermath of the Vietnam War, a behavioural pattern was observable in many of
the returning American soldiers. They were emotionally distant, irritable, had trouble sleeping and
were prone to severe fits of anger. Anti-Vietnam War activists advocating the troubled veterans
coined the term 'post-Vietnam Syndrome to describe their array of severe psychological symptoms.

B The type of trauma that leads to PTSD is almost always unexpected, and leaves the person
involved feeling powerless to stop the traumatic event. Situations that are likely to result in such
trauma are varied. Accidents, serious crimes, combat experience and the sudden death of loved
ones can all lead to PTSD. However, not everyone who experiences trauma develops PTSD, and
researchers are still trying to figure out why some people are more susceptible to this condition.

C Symptoms of PTSD can include persistent memories or nightmares about a traumatic event,
dissociation from the surrounding world, avoidance of anything related to the trauma and increased
anxiety or 'hyper arousal'. People with PTSD are constantly on guard for danger even when there
is no indication of threat in their immediate environment. This heightened state of anxiety or
irritability has other consequences as well, such as being prone to outbursts of anger or violent
aggression, having difficulties concentrating, and having trouble sleeping.

D Contrary to common belief, PTSD is a treatable disorder, and there is a range of treatments
available to PTSD sufferers. Once a patient is diagnosed with PTSD, they are almost always put
on some form of anti-anxiety or anti-depressant medication, which will often be used in conjunction
with some form of therapy. The most effective therapeutic models for PTSD sufferers are exposure
therapy, eye movement desensitisation and reprocessing (EMDR), and cognitive-behavioural
therapy (CBT). As the name suggests, exposure therapy involves exposing the patient to their
trauma in a safe environment so that they can become desensitised. EMDR combines exposure
therapy with guided eye movements that help individuals process traumatic memories. CBT, on the
other hand, teaches patients skills such as relaxation and mindfulness techniques that help them
deal with their memories of trauma more effectively. Although these treatments can be highly
effective, many victims of PTSD will experience painful relapses during the course of their lives;
ensuring the long-term availability of care and support is thus of paramount importance.

i. Various types of care for PTSD patients 1. Paragraph A

ii. Some symptoms of PTSD 2. Paragraph B

iii. The difficulty of detecting PTSD 3. Paragraph C

iv. The meaning and origin of the term PTSD 4. Paragraph D

v. The effect on families

vi. Why meditation helps PTSD

vii.Causes of trauma that can lead to PTSD

ANTIBIOTIC RESISTANCE ON THE RISE

A Alegacy of decades of overuse, antibiotic resistance is spreading across the globe and has
been recognised by professionals as one of the most dangerous threats to global health and
development. Antibiotic resistance arises when mutate and become impervious to the effects of
antibiotics, either through genetic mutation or through a gradual build-up of resistance. The
bacteria that emerge are extremely difficult to treat, and in some cases no medicines exist to
counter them. This is becoming such a pressing problem that the World Health Organication has
described it as 'one of the biggest threats to global health', and has introa global action plan in an
attempt to counter it.

B Antibiotic resistance emerged because of decades of misuse due to the despread availability
and a lack of education about the capabilities of these drugs. This was exacerbated by the
unregulated sale of antibiotic drugs over the counter without a doctor's prescription. It is estimated
that around half of is antibiotic use is unnecessary. For example, many people take antibiotics for
the common cold even though they have no impact on viruses. The overuse of antibiotics causes
the development of stronger bacteria, as antibiotics kill off all the weak bacteria, allowing the
stronger strains to multiply and develop immunity to the drugs that are designed to treat them.

C These strains of bacteria are known as multidrug resistant, or superbugs, and are a major
health risk throughout the world. It is estimated that millions die every year from these drug
resistant bacteria, and the number of infections that are untreatable is growing. A few common
bacterial infections, including pneumonia, E. coli and gonorrhea, are now developing immunity to
antibiotics and researchers are struggling to find alternative treatments. It has been predicted that,
if uncontrolled antibiotic resistant bacteria wil kill up to 300 million people by 2050.

D It is not just misuse in humans that contributes to antibiotic resistance but also excessive
prescription for animals. It is estimated that 80 per cent of antibiotics soid in the United States are
given to animals, and they are generally not given to sick animals. Indeed, it is often standard
practice in large farms to mix antibiotcs with general feed to improve the animals' health and well-
being. As with humans this acts as a catalyst for the development of drug resistant bacteria, which
can spread into food products and infect humans.

E The fight against antibiotic resistance is a global health priority, and resed laboratories around
the world are working on solutions to the issue. Developing new types of antibiotics is no longer a
feasible option, as the drug resistant strains of bacteria are appearing at such a rate that
countering them directly with new antibiotics is impossible. However, there has been that a recent
breakthrough that could be significant; scientists have discovered a molecule that reverses
antibiotic resistance in multiple strains of bacteria. This could allow doctors to use medicines that
are currently thought to be useless. This molecule has yet to be tested on humans, so it is still at
an early stage of the development. It may nonetheless be the best hope against this increasing
global health threat.

Which paragraph contains the following information?

1. an account of now food could be infected with drug resistant bacteria

2. a mention of the purchase of medicine without consulting a doctor

3. a reference to a possible new treatment

4. a statement about the number of people whose lives might be at risk

5. an account of how a global body has responded to this issue

 DOES YAWNING HAVE A FUNCTION?
Theories for why we yawn date back more than 2,000 years to the time of 'Hippocrates, who
considered yawning to be the respiratory system's way of removing bad air from the lungs.
Centuries later, scientists claimed that yawning indicated a lak of oxygen to the brain. Today, we
know that neither of these theories has strong scientific merit, prompting contemporary

researchers to carry on trying to unravel the mystery of our most common biological reflexes.

Robert Provine, a neuroscientist at the University of Maryland, points to obvious, noting that people
tend to yawn most when they are bored, hungry, and fatigued. Because all of these states can
easily lead to the inability to focus on whatever task is at hand, he believes that yawning is our
bodies' way of alerting us that we need to perk up. When this theory was tested, it was found that
subject did in fact tend to engage in some sort of physical activity directly after yawning, suggesting
that the subject’s yawns led to their getting up and seeking out of stimulation. Essentially, Provine
contends that yawning occurs due to an absence of stimuli and is simply how our bodies try to
regain focus.

Then again, so many things seem to cause people to yawn that it is hardly satistying to simply
blame a lack of stimulation. One situation many of us are probably familiar with is being unable to
control ourselves from yawning after seeing someone else yawn. A team of researchers from the
University of Leeds headed by Catriona Morrison believe that this has to do with our inclination to
show empathy for other people. In other words, if someone yawns in exhaustion, and others in the
room follow suit, it is likely because they identify with and feel sympathy for the original yawner.
This claim is substantiated by studies demonstrating that yawning is most contagious among
members of the same family or social group and lowest among those with autism and psychopathy,
conditions associated with the inability to empathise.

Meanwhile, evolutionary psychologist Gordon Galup of the University of Albany builds on both
Provine's and Morrison's theories with his hypothesis that yawning developed as a way to alert
group members to potential threats. Agreeing that yawning is followed by a feeling of improved
attentiveness and that it is contagious, he believes that early humans capitalised on these effects
to quickly convey the message to others that it was necessary to be on guard against attacks.
Essentially, if everyone was yawning and feeling more alert because of it, the likelihood of falling
prey to a predator was far lower.

Match each statement with the correct researcher, A, B or C.

1. Yawning may be linked to the ability to experience the same emotions as the people around us.

2. The contagiousness of yawning helped to promote alertness among members of a group

3. Yawning results from lack of stimuli and is an attempt by our bodies to refocus

List of Researchers

A. Gordon Gallup B. Robert Provine C. Catriona Morrison

GENE THERAPY: A REVOLUTIONARY

TREATMENT
Millions of dollars are spent on medical research each year, and although new techniques are
being developed and important discoveries are being made at an unprecedented rate, the cures for
a number of life-threatening diseases, like cancer and AIDS continue to elude scientists. But there
may be hope in the form of a treatment knowwnn as gene therapy, which involves using genetic
material to manipulate a patient's cells. The idea was first proposed in 1972 by Theodore
Friedmann and Richard Roblin in “Gene Therapy for Human Genetic Disease?” This article cited
US physician Stanfield Roger’s early notion that healthy DNA could be used to replace defective
DNA in people with genetic disorders. Building off Roger's idea, Friedmann and Roblin suggested
ways in which healthy DNA could be used to fix, replace, or supplement a faulty gene to make

it functions properly. Researchers quickly latched onto this innovative new concept, and the first
gene therapy case was approved in the United States in September of 1990.

Although gene therapy has successfully cured patients with diseases such as leukaemia,
haemophilia, and Parkinson's disease in the years since then, it is not without its problems. The
most difficult part of administering healthy DNA to a patient is getting the unhealthy cell to accept it.
While techniques that involve directly injecting the healthy DNA into the recipient cell have shown
some success, the more commonly employed method is through the use of a vector a DNA
molecule that serves as a vehicle to carry foreign genetic material into another cell.

Viruses are the most commonly used vectors because they naturally invade cells. When they are
used, some of the virus's DNA is removed and replaced with the therapeutic DNA, but the virus's
structural sequence stays intact and serves as the "backboneo the vector. This tricks the patient's
cells into allowing it to enter, but it does not always work as hoped. This is due to the fact that there
is always the chance the patient’s immune system will kick in and fight off the virus, killing the
therapeutic gene at e same time. This process can produce an inflammatory response within the
patient, a in certain cases, lead to organ failure.

Alternatively, the viral vector could potentially cause disease once inside the patient and even
target more cells than it is supposed to, including ones that are healthy. Because of these risks,
gene therapy is still considered experimental and the only way to receive it is through participation
in a clinical trial. Doctors still have a long way to go before they understand all the potential effects
gene therapy can have on a person's body, so research is likely to continue until further
breakthroughs are made and both the Food and Drug Administration and the National Institutes of
Health deem the treatment safe enough to enter mainstream medical practice.

Complete each sentence with the correct ending. A-G, below.

1. When a virus is used as a vector, its structure

2. When an immune system fight virus, it also

3. Due to certain dangers, gene therapy

A. destroys any genetic material that is meant to cure disease.

B. manages to cure a life-threatening disease.

C. accepts the healthy DNA that is added.

D. retains its basic form.

E. remains experimental for now.

F. invades the cells of the patient.

G. removes the diseased elements.

THE UNSTOPPABLE RISE OF BURGER AND FRIES

A lt is astonishing to contemplate how popular junk food has become, given that the 'first fast
food restaurant in the US only opened its doors a mere century ago. Since then, high-calorie
processed meals have taken over the world, with multinational restaurant chains aggressively
chasing levels of growth that show no signs of slowing down. Much of this expansion is currently
taking place in less developed parts of the world, where potential for customer loyalty is seen as
easier to develop, but it is not just in these areas where such growth is visible. Indeed, a recent
study from the University of Cambridge found that the number of takeaways in the United Kingdom
rose by 45 per cent between 1997 and 2015. This explosion in the takeaway trade is not an
inevitable outcome of what we call 'progress'. On the contrary, it comes in the face of an increasing
body of evidence that we are heading for dietary disaster.

B Yet, despite nutrition experts' best efforts to educate people about the dangers of a diet filled
with processed food, it appears that the world doesn't want to listen. Medical specialists point out
that, although eating too much unhealthy food is likely to be as dangerous in the long-term as
smoking, regular consumption of high-calorie food has somehow become more socially acceptable
than ever. While local authorities in some towns and cities have taken measures to combat the rise
in this trend by limiting the riumber of fast food outlets permitted to be open simultaneously, critics
argue that people have every right to make their own decisions about what they eat and how they
choose to live. However, the way in which we have come to binge on takeaways isn't only a
personal issue of weight gain, or of buying larger clothes. The consequences of mass
overconsumption should strike fear into the hearts of everyone.

C Research suggests that there is an evolutionary reasonas to why people compulsively overeat -
it is simply part of our innate behaviour. When humans evolved, we did not have the abundant
supply of food that we enjoy today, and so eating was more about survival than pleasure. We
became more likely to opt for high-calorie foods, with high fat content, that could sustain us through
cold winters when the supply of nourishment became sparse. This explains why a 600-calorie
burger seems so attractive: it awakens our primal side, makes us feel well fed, inspires
contentment. Processed food stimulates the reward response in our brains, so we feel compelled
to overeat, and not necessarily in a healthy way. Junk food acts as a trigger for chemicals such as
the 'feel-good' dopamine to flood through the brain and induce a sensation of happiness.
Meanwhile, high amounts of sugar and sodium (one of the chemicals in salt and other ingredients
of fast food) cause a huge surge in blood sugar, pushing it to unnatural levels.

D This occurs within the first few moments of eating a high-calorie meal. From there, routinely
processing such high levels of sodium is impossible, and the body's organs are pushed beyond
their natural working capacity in trying to do so. The kidneys cannot remove all the excess salt from
the blood, and thus an overdose of sodium causes the heart to pump faster while transporting
blood through the veins. There are multiple dangers of high blood pressure, especially for the
elderly and in the long-term. Sodium taken on in such quantities can lead to dehydration, a
condition whose symptoms are extremely similar to hunger, and this leads to a painful truth: as
soon you have finished your junk food meal, you immediately start to crave another. Thereafter, the
body starts to digest the food. Usually, this takes between four and 12 hours, but with fast food,
where the fat content is so much higher, the same process lasts at least three days.

E A number of studies have shown how young people can become even more addicted to junk
food than adults. When a child eats a burger, the same neurological processes occur as in their
parents: their brain's reward system is awoken, dopamine is released, a spontaneous feeling of
excitement results, their blood sugar rockets, and so on. An adult can apply their maturity to
understand that this thrill is not entirely without drawbacks, and that they need to control their urge
to eat more. However, a child cannot necessarily see any negative consequences to this urge and
the potential effects of their lack of self-control, so they find it far more difficult to exercise restraint
and moderate their food consumption.

F lt is common to read or to hear criticism of the junk food industry that does so much to
promote the overconsumption of its products. But it does not appear that any of this criticism is
changing widespread dietary habits in any substantial way. What is more, the humble burger has
been elevated to such a point that many people no longer see it as simple, on-the-go food. It has
arguably become a stylish and aspirational part of one's daily diet. Consider, for example, how
some television companies recently made several series of programmes encouraging unnecessary
overeating, in which the host devours dish after dish ofunhealthy, fatty meals until they are full -
and then far, far beyond. While such glamorisation exists, it is difficult to see how our collective
march towards a global obesity crisis can ever be halted.

Choose NO MORE THAN TWO WORDS from the passage for each answer.

The effects of fast food on the body

Reward response activated by 1.______________

Huge quantities of dopamine produced in 2._______________

Blood sugar 3._____________

4. _____________fail to remove unneeded sodium from the blood

Present particular risks for 5.___________

 Dehydration (signs of this resemble 6.___________)

Food broken down slowly (minimum 7._____________)

Differences in adults and child reactions to eating processed food

Adult Child
Eats-dopamine released. Eats-dopamine released.
Reward system activated Reward system activated
Can understand the negative consequences Cannot understand the negative consequences
Rationalizes excite money by relying on Unable to resist the 9.____________to consume
8. _____________ more food
Can hold back cravings Do not show 10._____________
Stop eating Continues to eat

Choose NO MORE THAN TWO WORDS from the text to Complete the sentences.

1. Global food corporations are fiercely pursuing ways in which to increase their ____________

2. The fast-food industry is particularly building its presence in areas that are ______________

3. Despite more and more proof of its negative effects, the huge success of the fast

food industry is leading us into ____________

Choose NO MORE THAN TWO WORDS from the text for each answer.

1. Much of the public seems unconvinced that if they eat an excess of___processed food____ ,
they will become ill.

2. Many urban councils have developed initiatives to change fast food consumption habits by
issuing restrictions on how many ____outlets_________ can sell fast food.

3. A number of scientists believe that an instinctive characteristic people share causes them
to__(compulsively) overeat______

4. One problem is that a fast food diet has become glamorous and ___aspirational_______
 THE GROWING GLOBAL THREAT OF
ANTIBIOTIC RESISTANCE
Antibiotics have been one of humanity's success stories for hundreds of years, being
responsible both for saving the lives of millions of patients and for helping scientists to take
enormous steps in the fields of medical and surgical treatment. But this success has come at a
price. The growing resistance of many bacterial strains to the curative effects of antibiotics is such
a concern that it has been referred to, in some quarters, as the greatest threat to our continued
existence on earth. We have become careless, it is argued, not only in our reliance on the quick fix
of medicine if we feel even slightly under the weather, but also in taking the availability of antibiotics
for granted, using them incorrectly, not following the prescribed dosage. This has given rise to a
new form of superbacteria, a type which is able to fight off antibiotic treatment with ease.

Although their resistance to antibiotics has been built up over a long period of time, bacteria
actually replicate extraordinarily quickly, and any resistance developed is also duplicated as they
divide. In addition, those bacteria carrying resistance genes happen to spread those genes further
via 'horizontal gene transfer', a process whereby one bacterium passes on the resistance gene
from another without even needing to be its parent. What makes the spread of these strains more
difficult to control is that it occurs in a cyclical process. In the case of humans, when a person
becomes infected and the resistant bacteria set up home in the gut, the sufferer has two choices:
look for help or stay at home. In seeking medical assistance, whether through an appointment to
visit their local doctor, or taking themselves to hospital, they contaminate other patients, later to be
discharged and sent home. The resistant bacteria then spread out into the local community. This is
also the end result if the infected person decides not to seek any medicalassistance at all: they
keep the bacteria at home and allow them to breed without treatment.

Livestock also play their part in dispersing these newly evolved, bullet-proof microorganisms
into the food chain. These resilient bacteria do not discriminate between man and beast, and so
animals play host to the very same bacteria as are found in humans, with the end result that our
farms and abattoirs have become breeding grounds for inter-species infection. In fact, even after
slaughter, these bacteria can easily survive on animal carcasses, remaining alive and reproducing
until the point of purchase and beyond, eventually invading our systems when we ingest the flesh
as infected meat. So is the answer simply to become a vegetarian? Sadly not. The very same
resistant bacteria will leave a host animal's gut in the form of faeces, which are employed in
agriculture as manure to support food crops. From there, the wheat, maize and corn that are grown
for human consumption transport the bacteria into our bodies. There really is no escape.
 That said, there is always something that can be done to try and minimise any risk, however
much of a lost cause it might seem. In 2014, after accumulating data from 114 countries, the World
Health Organization (WHO), issued a set of guidelines intended to tackle the increasing problem of
resistance. Doctors and pharmacists were advised to avoid prescribing and dispensing antibiotics
as much and as often as possible. Only when treatment is utterly necessary should they resort to
doing so, while the greatest of care should be taken to ensure that the antibiotics they provide are
the correct ones to treat the illness. In turn, the general public must play their part by only taking
antibiotics as prescribed by a doctor, as well as making sure they see out the full course, even if
they feel better before the antibiotics are finished. Additionally, they should never share their
medication with others or - astonishing as it may seem that this would need to be stated - buy
drugs online.

Away from the individual and onto organisations, the WHO has urged policymakers to invest
in laboratory capacity and research to track increasing drug resistance as it happens, over time.
Our leaders and governors were also advised to ensure that use of antibiotics is strictly regulated,
something that can only be achieved through cooperation between themselves and the
pharmaceutical industry. If innovation in research were encouraged, and new tools developed, the
WHO argued, the threat might yet be contained. But herein lies the biggest challenge of all.
Antibiotic development has slowed down considerably over recent decades as the pharmaceutical
industry becomes ever more governed by profit margins. Since they are used for a relatively short
time, and are often effective in curing the patient, antibiotics are nowhere near as lucrative as the
drugs that treat long-term disorders, such as diabetes or asthma. Because medicines for chronic
conditions are so much more profitable, this is where pharmaceutical companies invest their time
and money. A further stumbling block is the relatively low cost of antibiotics, newer examples of
which tend to cost a maximum of £1,000 to £3,000 per course. When compared with cancer
chemotherapy, for example, a process of treatment that costs tens of thousands of pounds, the
discrepancy becomes impossible to mend.

As a race, humans have seen remarkable health benefits over the years as a huge number
of illnesses have been treated by antibiotics, but we now face a global emergency as
antibioticresistant bacteria are beginning to emerge more rapidly and frequently than ever before.
Not only has this created a potential health crisis, since we are increasingly unable to provide the
sick with treatment as a result of worldwide overuse of these drugs, but it is also unlikely to be
tackled any time soon, as the powerful pharmaceutical companies are primarily driven by profit and
see little benefit in researching and creating new antibiotics. It simply does not work on the balance
sheet, and so it falls to governments and individuals around the world to find ways to manage the
crisis. Coordinating such efforts will not be easy.
Write NO MORE THAN TWO WORDS for each blank

How antibiotic resistane spreads

Infected bacteria become established in 1.__________________

Human Animal

Bacteria survive on carcasses, following

5._____________

Patients opt for

2.____________

Bacteria multiply due to the Human consume

absence of 4.___________ 6.______________

3. ____________is infected, Bacteria enter our

Contamination spreads. 7.______________

Recommendations from World Health Organization

Medical professionals General public

- Only prescribe antibiotics when there is no - Only take antibiotics prescribed by a
alternative
- Prescribe or dispense correct treatment
on a case by case basis
Governments / policymakers
Give money towards increasing
10._______________with which to monitor
the continuing development of resistant to
antibiotics
doctor
- Take the complete 8._______________
Avoid 9._________________purchase of
medication
Pharmaceutical industry
Co-operate with policymakers to fund new
Kaiser research in order to find
11.____________with which to fight the
threat of antibiotic resistance.
12. The rapid emergence of antibiotic-resistant bacteria could put a stop to the _______ that have
been enjoyed by humanity.

13. Owing to its, antibiotic treatment of people with illnesses is_______________

14. With pharmaceutical companies preoccupied with profit, responsible governments and
individuals must take steps to tackle the _______________ themselves.

SAMPLE GROUP ASSIGNMENT:

RECEDING GUMS
Gum recession is the process in which the margin of the gum tissue that surrounds the teeth wears
away, or pulls back, exposing more of the tooth, or the tooth's root. When gum recession occurs,
"pockets," or gaps, form between the teeth and gum line, making it easy for disease-causing
bacteria to build up. If left untreated, the supporting tissue and bone structures of the teeth can be
severely damaged and may ultimately result in tooth loss.

Gum recession is a common dental problem. Most people don't know they have gum recession
because it occurs gradually. The first sign of gum recession is usually tooth sensitivity, or you may
notice a tooth looks longer than normal. Typically, a notch can be felt near the gum line.

Gum recession is not something you want to ignore. If you think your gums are receding, make an
appointment with your dentist. There are treatments that can repair the gum and prevent further
damage.

Why Do Gums Recede?

There are a number of factors that can cause your gums to recede, including:

Periodontal diseases. These are bacterial gum infections that destroy gum tissue and supporting
bone that hold your teeth in place. Gum disease is the main cause of gum recession.

Your genes. Some people may be more susceptible to gum disease. In fact, studies show that
30% of the population may be predisposed to gum disease, regardless of how well they care for
their teeth.

Aggressive tooth brushing. If you brush your teeth too hard or the wrong way, it can cause the
enamel on your teeth to wear away and your gums to recede.

Insufficient dental care. Inadequate brushing, flossing, and rinsing with antibacterial mouthwash
makes it easy for plaque to turn into calculus (tartar) -- a hard substance that builds on and
between your teeth and can only be removed by a professional dental cleaning. It can lead to gum
recession.

Hormonal changes. Fluctuations in female hormone levels during a woman's lifetime, such as in
puberty, pregnancy, and menopause, can make gums more sensitive and more vulnerable to gum
recession.

Tobacco products. Tobacco users are more likely to have sticky plaque on their teeth that is
difficult to remove and can cause gum recession.

Grinding and clenching your teeth. Clenching or grinding your teeth can put too much force on
the teeth, causing gums to recede.

Crooked teeth or a misaligned bite. When teeth do not come together evenly, too much force
can be placed on the gums and bone, allowing gums to recede.

Body piercing of the lip or tongue. Jewelry can rub the gums and irritate them to the point that
gum tissue is worn away.

How Is Gum Recession Treated?

Mild gum recession may be able to be treated by your dentist by deep cleaning the affected area.
During the deep cleaning -- also called tooth scaling and root planing -- plaque and tartar that has
built up on the teeth and root surfaces below the gum line is carefully removed and the exposed
root area is smoothed to make it more difficult for bacteria to attach itself. Antibiotics also may be
given to get rid of any remaining harmful bacteria.

If your gum recession cannot be treated with deep cleaning because of excess loss of bone and
pockets that are too deep, gum surgery may be required to repair the damage caused by gum
recession.

What Type of Surgery Is Used to Treat Gum Recession?

The following surgical procedures are used to treat gum recession:

Open flap scaling and root planing: During this procedure, the dentist or periodontist (gum
doctor) folds back the affected gum tissue, removes the harmful bacteria from the pockets, and
then snugly secures the gum tissue in place over the tooth root, thus eliminating the pockets or
reducing their size.

Regeneration: If the bone supporting your teeth has been destroyed as a result of gum recession,
a procedure to regenerate lost bone and tissue may be recommended. As in pocket depth
reduction, your dentist will fold back the gum tissue and remove the bacteria. A regenerative
material, such as a membrane, graft tissue, or tissue-stimulating protein, will then be applied to
encourage your body to naturally regenerate bone and tissue in that area. After the regenerative
material is put in place, the gum tissue is secured over the root of the tooth or teeth.

Soft tissue graft: There are several types of gum tissue graft procedures, but the most commonly
used one is called a connective tissue graft. In this procedure, a flap of skin is cut at the roof of
your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is
removed and then stitched to the gum tissue surrounding the exposed root. After the connective
tissue -- the graft -- has been removed from under the flap, the flap is stitched back down. During
another type of graft, called free gingival graft, tissue is taken directly from the roof of the mouth
instead of under the skin. Sometimes, if you have enough gum tissue surrounding the affected
teeth, the dentist is able to graft gum from near the tooth and not remove tissue from the palate.
This is called a pedicle graft.

How Can I Prevent Gum Recession?

The best way to prevent gum recession is to take good care of your mouth. Brush and floss your
teeth every day and see your dentist or periodontist at least twice a year, or as recommended. If
you have gum recession, your dentist may want to see you more often. Always use a soft-bristled
toothbrush and ask your dentist to show you the proper way to brush your teeth. If a misaligned
bite or teeth grinding is the cause of gum recession, talk to your dentist about how to correct the
problem. Other ways to prevent gum recession include:

- Quit smoking if you smoke.

- Eat a well balanced and healthy diet.
- Monitor changes that may occur in your mouth.
- By taking good care of your teeth, you can have a healthy smile forever.
 READING: ADVANCED

DOCTORING SALES
Pharmaceuticals is one of the most profitable industries in North America. But do the drugs
industry's sales and marketing strategies go too far?

A. A few months ago Kim Schaefer, sales representative of a minor global pharmaceutical
company, walked into a medical center in New York to bring information and free samples of her
company's latest products. That day she was lucky- a doctor was available to see her. 'The last rep
offered me a trip to Florida. What do you have?' the physician asked. He was only half joking.

B. What was on offer that day was a pair of tickets for a New York musical. But on any given day
what Schaefer can offer is typical for today's drugs rep -a car trunk full of promotional gifts and
gadgets, a budget that could buy lunches and dinners for a small county hundreds of free drug
samples and the freedom to give a physician $200 to prescribe her new product to the next six
patients who fit the drug's profile. And she also has a few $ 1,000 honoraria to offer in exchange for
doctors' attendance at her company's next educational lecture.

C. Selling Pharmaceuticals is a daily exercise in ethical judgment. Salespeople like Schaefer walk
the line between the common practice of buying a prospect's time with a free meal, and bribing
doctors to prescribe their drugs. They work in an industry highly criticized for its sales and marketing
practices, but find themselves in the middle of the age-old chicken-or-egg question - businesses
won't use strategies that don't work, so are doctors to blame for the escalating extravagance of
pharmaceutical marketing? Or is it the industry's responsibility to decide the boundaries?

D. The explosion in the sheer number of salespeople in the Reid- and the amount of funding used
to promote their causes- forces close examination of the pressures, influences and relationships
between drug reps and doctors. Salespeople provide much-needed information and education to
physicians. In many cases the glossy brochures, article reprints and prescriptions they deliver are
primary sources of drug education for healthcare givers. With the huge investment the industry has
placed in face-to-face selling, sales people have essentially become specialists in one drug or group
of drugs - a tremendous advantage in getting the attention of busy doctors in need of quick
information.
E. But the sales push rarely stops in the office. The flashy brochures and pamphlets left by the
sales reps are often followed up with meals at expensive restaurants, meetings in warm and sunny
places, and an inundation of promotional gadgets. Rarely do patients watch a doctor write with a pen
that isn't emblazoned with a drug's name, or see a nurse use a tablet not bearing a pharmaceutical
company's logo. Millions of dollars are spent by pharmaceutical companies on promotional products
like coffee mugs, shirts, umbrellas, and golf balls. Money well spent? It's hard to tell. I've been the
recipient of golf balls from one company and I use them, but it doesn't make me prescribe their
medicine,' says one doctor.' I tend to think I'm not influenced by what they give me.'

F. Free samples of new and expensive drugs might be the single most effective way of getting
doctors and patients to become loyal to a product. Salespeople hand out hundreds of dollars' worth
of samples each week-$7.2 billion worth of them in one year. Though few comprehensive studies
have been conducted, one by the University of Washington investigated how drug sample availability
affected what physicians prescribe. A total of 131 doctors self-reported their prescribing patterns-the
conclusion was that the availability of samples led them to dispense and prescribe drugs that differed
from their preferred drug choice.

G. The bottom line is that pharmaceutical companies as a whole invest more in marketing than they
do in research and development. And patients are the ones who pay-in the form of sky-rocketing
prescription prices for every pen that's handed out, every free theatre ticket, and every steak dinner
eaten. In the end, the fact remains that pharmaceutical companies have every right to make a profit
and will continue to find new ways to increase sales. But as the medical world continues to grapple
with what's acceptable and what's not, it is clear that companies must continue to be heavily
scrutinized for their sales and marketing strategies.

Questions 1-7: Choose the correct heading for each paragraph from the list of headings

List of Headings

i. Not all doctors are persuaded

ii. Choosing the best offers
iii. Who is responsible for the increase in promotions?
iv. Fighting the drug companies
v. An example of what doctors expect from drug companies
vi. Gifts include financial incentives
vii. shows that promotion works
viii. The high costs of research
ix. The positive side of drugs promotion
x. Who really pays for doctors' free gifts?

1. Paragraph A
2. Paragraph B
3. Paragraph C
4. Paragraph D
5. Paragraph E
6. Paragraph F
7. Paragraph G

Questions 8-13

YES if the statement agrees with the views of the writer

NO if the statement contradicts the views of the writer

NOT GIVEN if it is impossible to say what the writer thinks

8. Sales representatives like Kim Schaefer work to a very limited budget.

9. Kim Schaefer's marketing technique may be open to criticism on moral grounds.

10. The information provided by drug companies is of little use to doctors.

11. Evidence of drug promotion is clearly visible in the healthcare environment.

12. The drug companies may give free drug samples to patients without doctors'
prescriptions
13. It is legitimate for drug companies to make money.
 THE SEARCH FOR THE ANTI-AGING PILL
In government laboratories and elsewhere, scientists are seeking a drug able to prolong life and
youthful vigor. Studies of caloric restriction are showing the way

As researchers on aging noted recently, no treatment on the market today has been
proved to slow human aging- the build-up of molecular and cellular damage that increases
vulnerability to infirmity as we grow older. But one intervention, consumption of a low-calorie* yet
nutritionally balanced diet, works incredibly well in a broad range of animals, increasing longevity
and prolonging good health. Those findings suggest that caloric restriction could delay aging and
increase longevity in humans, too.

Unfortunately, for maximum benefit, people would probably have to reduce their
caloric intake by roughly thirty percent, equivalent to dropping from 2,500 calories a day to 1, 750.
Few mortals could stick to that harsh a regimen, especially for years on end. But what if someone
could create a pill that mimicked the physiological effects of eating less without actually forcing
people to eat less? Could such a 'caloric-restriction mimetic', as we call it, enable people to stay
healthy longer, postponing age-related disorders (such as diabetes, arteriosclerosis, heart disease
and cancer) until very lace in life? Scientists first posed this question in the mid-1990s, after
researchers came upon a chemical agent that in rodents seemed to reproduce many of caloric
restriction's benefits. No compound that would safely achieve the same feat in people has been
found yet, but the search has been informative and has fanned hope that caloric-restriction (CR)
mimetics can indeed be developed eventually.

The benefits of caloric restriction

The hunt for CR mimetics grew out of a desire to better understand caloric restriction's
many effects on the body. Scientists first recognized the value of the practice more than 60 years
ago, when they found that rats fed a low-calorie diet lived longer on average than free-feeding rats
and also had a reduced incidence of conditions that become increasingly common in old age. What
is more, some of the treated animals survived longer than the oldest-living animals in the control
group, which means that the maximum lifespan (the oldest attainable age), not merely the normal
lifespan, increased. Various interventions, such as infection-fighting drugs, can increase a
population's average survival time, but only approaches that slow the body's rate of aging will
increase the maximum lifespan.

The rat findings have been replicated many times and extended to creatures ranging
from yeast to fruit flies, worms, fish, spiders, mice and hamsters. Until fairly recently, the studies
were limited short-lived creatures genetically distant from humans. But caloric-restriction projects
underway in two species more closely related to humans- rhesus and squirrel monkeys- have
scientists optimistic that CR mimetics could help people.
 Calorie: a measure of the energy value of food.

The monkey projects demonstrate that compared with control animals that eat
normally. caloric-restricted monkeys have lower body temperatures and levels of the pancreatic
hormone insulin, and they retain more youthful levels of certain hormones that tend to fall with age.

The caloric-restricted animals also look better on indicators of risk for age-related
diseases. For example, they have lower blood pressure and triglyceride levels(signifying a
decreased likelihood of heart disease) and they have more normal blood glucose levels( pointing to
a reduced risk for diabetes, which is marked by unusually high blood glucose levels). Further, it has
recently been shown that rhesus monkeys kept on caloric-restricted diets for an extended
time( nearly 15 years) have less chronic disease. They and the other monkeys must be followed
still longer, however, to know whether low-calorie intake can increase both average and maximum
lifespans in monkeys. Unlike the multitude of elixirs being touted as the latest anti-aging cure, CR
mimetics would alter fundamental processes that underlie aging. We aim to develop compounds
that fool cells into activating maintenance and repair.

How a prototype caloric-restriction mimetic works

The best-studied candidate for a caloric-restriction mimetic, 2DG (2-deoxy-D-glucose),

works by interfering with the way cells process glucose, it has proved toxic at some doses in
animals and so cannot be used in humans. But it has demonstrated that chemicals can replicate
the effects of caloric restriction; the trick is finding the right one.

Cells use the glucose from food to generate ATP (adenosine triphosphate), the
molecule that powers many activities in the body. By limiting food intake, caloric restriction
minimizes the amount of glucose entering cells and decreases ATP generation. When 2DG is
administered to animals that eat normally, glucose reaches cells in abundance but the drug
prevents most of it from being processed and thus reduces ATP synthesis. Researchers have
proposed several explanations for why interruption of glucose processing and ATP production
might retard aging. One possibility relates to the ATP-making machinery's emission of free radicals,
which are thought to contribute to aging and t such age-related diseases as cancer by damaging
cells. Reduced operation of the machinery should limit their production and thereby constrain the
damage. Another hypothesis suggests that decreased processing of glucose could indicate to cells
that food is scarce( even if it isn't) and induce them to shift into an anti-aging mode that
emphasizes preservation of the organism over such 'luxuries' as growth and reproduction.

Questions 28-32

Do the following statements agree with the claims of the writer in Reading Passage 3?
YES if the statement t agrees with the claims of the writer

NO if the statement contradicts the claims of the writer

NOT GIVEN if it is impossible to say what the writer thinks about this

28. Studies show drugs available today can delay the process of growing old.

29. There is scientific evidence that eating fewer calories may extend human life.

30. Not many people are likely to find a caloric-restricted diet attractive.

31. Diet-related diseases are common in older people.

32. In experiments, rats who ate what they wanted to lead shorter lives than rats on a low calorie
diet.

Questions 33-37

Classify the following descriptions as relating to

A caloric-restricted mimetic

B control monkeys

C neither caloric-restricted monkeys nor control monkeys

33. Monkeys were less likely to become diabetic.

34. Monkeys experienced more chronic disease.

35. Monkeys have been shown to experience a longer than average life span.

36. Monkeys enjoyed a reduced chance of heart disease.

37. Monkeys produced greater quantities of insulin.

Questions 38-40

Choose NO MORE THAN TWO WORDS from the passage for each answer.

How a caloric-restriction mimetic works

 THE RISKS OF CIGARETTE SMOKE
Discovered in the early 1800s and named nicotianine, the oily essence now called
nicotine is the main active ingredient of tobacco. Nicotine, however, is only a small component of
cigarette smoke, which contains more than 4,700 chemical compounds, including 43 cancer-
causing substances. In recent times, scientific research has been providing evidence that years
of cigarette smoking vastly increases the risk of developing fatal medical conditions.

In addition to being responsible for more than 85 per cent of lung cancers, smoking is
associated with cancers of, amongst others, the mouth, stomach and kidneys, and is thought to
cause about 14 per cent of leukemia and cervical cancers. In 1990, smoking caused more than
84,000 deaths, mainly resulting from such problems as pneumonia, bronchitis and influenza.
Smoking, it is believed, is responsible for 30 per cent of all deaths from cancer and clearly
represents the most important preventable cause of cancer in countries like the United States
today.

Passive smoking, the breathing in of the side-stream smoke from the burning of
tobacco between puffs or of the smoke exhaled by a smoker, also causes a serious health risk. A
report published in 1992 by the US Environmental Protection Agency (EPA) emphasized the
health dangers, especially from side-stream smoke. This type of smoke contains more, smaller
particles and is therefore more likely to be deposited deep in the lungs. On the basis of this
report, the EPA has classified environmental tobacco smoke in the highest risk category for
causing cancer.

As an illustration of the health risks, in the case of a married couple where one partner
is a smoker and one a non-smoker, the latter is believed to have a 30 per cent higher risk of
death from heart disease because of passive smoking. The risk of lung cancer also increases
over the years of exposure and the figure jumps to 80 per cent if the spouse has been smoking
four packs a day for 20 years. It has been calculated that 17 per cent of cases of lung cancer can
be attributed to high levels of exposure to second-hand tobacco smoke during childhood and
adolescence.

A more recent study by researchers at the University of California at San Francisco

(UCSF) has shown that second-hand cigarette smoke does more harm to non-smokers than to
smokers. Leaving aside the philosophical question of whether anyone should have to breathe
someone else's cigarette smoke, the report suggests that the smoke experienced by many
people in their daily lives is enough to produce substantial adverse effects on a person's heart
and lungs.
 The report, published in the Journal of the American Medical Association (AMA), was
based on the researchers' own earlier research but also includes a review of studies over the
past few years. The American Medical Association represents about half of all US doctors and is
a strong opponent of smoking. The study suggests that people who smoke cigarettes are
continually damaging their cardiovascular system, which adapts in order to compensate for the
effects of smoking. It further states that people who do not smoke do not have the benefit of their
system adapting to the smoke inhalation. Consequently, the effects of passive smoking are far
greater on non-smokers than on smokers.

This report emphasizes that cancer is not caused by a single element in cigarette
smoke; harmful effects to health are caused by many components. Carbon monoxide, for
example, competes with oxygen in red blood cells and interferes with the blood's ability to deliver
life giving oxygen to the heart. Nicotine and other toxins in cigarette smoke activate small blood
cells called platelets, which increases the likelihood of blood clots, thereby affecting blood
circulation throughout the body.

The researchers criticize the practice of some scientific consultants who work with the
tobacco industry for assuming that cigarette smoke has the same impact on smokers as it does
on non-smokers. They argue that those scientists are underestimating the damage done by
passive smoking and, in support of their recent findings, cite some previous research which
points to passive smoking as the cause for between 30,000 and 60,000 deaths from heart attacks
each year in the United States. This means that passive smoking is the third most preventable
cause of death after active smoking and alcohol-related diseases.

The study argues that the type of action needed against passive smoking should be
similar to that being taken against illegal drugs and AIDS (SIDA). The UCSF researchers
maintain that the simplest and most cost-effective action is to establish smoke-free work places,
schools and public places.

Questions 1-3

Choose the appropriate letters A—D

1. According to information in the text, leukaemia and pneumonia

A. are responsible for 84,000 deaths each year.

B. are strongly linked to cigarette smoking.

C. are strongly linked to lung cancer.

D. result in 30 per cent of deaths per year.

2. According to information in the text, intake of carbon monoxide

A. inhibits the flow of oxygen to the heart.

B. increases absorption of other smoke particles.

C. inhibits red blood cell formation.

D. promotes nicotine absorption.

3. According to information in the text, intake of nicotine encourages

A. blood circulation through the body.

B. activity of other toxins in the blood.

C. formation of blood clots.

D. an increase of platelets in the blood.

Questions 4-7

Do the following statements reflect the claims of the writer in Reading Passage ?

YES if the statement reflects the claims of the writer

NO if the statement contradicts the claims of the writer

NOT GIVEN if it is impossible to say what the writer thinks about this

4. Thirty per cent of deaths in the United States are caused by smoking-related diseases.

5. If one partner in a marriage smokes, the other is likely to take up smoking.

6. Teenagers whose parents smoke are at risk of getting lung cancer at some time during their
lives.

7. Opponents of smoking financed the UCSF study.

Questions 8-10

Choose ONE phrase from the list of phrases A-J below to complete each of the following
sentences
8. Passive smoking

9. Compared with a non-smoker, a smoker

10. The American Medical Association

A. includes reviews of studies in its reports.

B. argues for stronger action against smoking in public places.

C. is one of the two most preventable causes of death.

D. is more likely to be at risk from passive smoking diseases.

E. is more harmful to non-smokers than to smokers.

F. is less likely to be at risk of contracting lung cancer.

G. is more likely to be at risk of contracting various cancers.

H. opposes smoking and publishes research on the subject.

I. is just as harmful to smokers as it is to non-smokers.

J. reduces the quantity of blood flowing around the body.

Questions 11-14

Write the appropriate letters A-D in boxes 11-14 on your answer sheet.

NB You may use any letter more than once.

11. Smokers’ cardiovascular systems adapt to the intake of environmental smoke.

12. There is a philosophical question as to whether people should have to inhale others’ smoke.

13. Smoke-free public places offer the best solution.

14. The intake of side-stream smoke is more harmful than smoke exhaled by a smoker.

Classify the following statements as being

A. a finding of the UCSF study

B. an opinion of the UCSF study

C. a finding of the EPA report

D. an assumption of consultants to the tobacco industry

 CHANGING RULES FOR HEALTH TREATMENT
People who are grossly overweight, who smoke heavily or drink excessively could be denied
surgery or drugs. The National Institute for Health and Clinical Excellence (NICE), which advices on
the clinical and cost-effectiveness of treatments for the National Health Service (NHS) in the UK,
said that in some cases the- ‘self-inflicted’ nature of an illness should be taken into account.

NICE stressed that people should not be discriminated against by doctors simply because
they smoke or were overweight. Its ruling should apply only if the treatment was likely to be less
effective, or not work because of an unhealthy habit. The agency also insisted that its decision was
not an edict for the whole NHS but guidance for its own appraisal committees when reaching
judgments on new drugs or procedures. But the effect is likely to be the same.

NICE is a powerful body and the cause of much controversy. It is seen by some as a new way
of rationing NHS treatment. Across the UK, primary care trusts (PCTs) regularly wait for many
months for a NICE decision before agreeing to fund a new treatment. One group of primary care
trusts is ahead of NICE. Three PCTs in east Suffolk have already decided that obese people would
not be entitled to have hip or knee replacements unless they lost weight. The group said the risks of
operating on them were greater, the surgery may be less successful and the joints would wear out
sooner. It was acknowledged that the decision would also save money.

NICE said no priority should be given to patients based on income, social class or social roles
at different ages when considering the cost-effectiveness of a treatment. Patients should not be
discriminated against on the grounds of age either unless age has a direct relevance to the
condition. NICE has already ruled that IVF should be available on the NHS to women aged 23 to 39
as the treatment has less chance of success in older women. It also recommends that flu drugs
should be available to over-65s, as older people are more vulnerable.

But NICE also said that if self-inflicted factors meant that drugs or treatment would be less
clinically and cost-effective, this may need to be considered when producing advice for the NHS.
They state that ‘if the self-inflicted cause of the condition will Influence the likely outcome of it
particular treatment, then it may be appropriate to take this into account in some circumstances’.
They acknowledge that it can be difficult to decide whether an Illness such as a heart attack was
self-inflicted in a smoker. ‘A patient’s individual circumstances may only be taken Imo account when
there will be an impact on the clinical and cost-effectiveness of the treatment.

Prof Sir Michael Rawlins, the chairman of NYC, said: ‘On age, we are very clear – our
advisory groups should not make recommendations that depend on people’s ages when they are
considering the use of it particular treatment, unless there is clear evidence of a difference in its
effectiveness for particular age groups. Even then, age should only be mentioned when it provides
the only practical ‘market of risk or benefit. NICE values people, equally, at all ages’.

But Steve ‘Webb, the Liberal Democrat health spokesman, said there was a danger of primary
care trusts following the same course of action. ‘There is no excuse for cash-strapped hospitals
denying treatment to people whose lifestyle they disapprove of, he said. ‘Treatment decisions
involving people’s lifestyle should be based on clinical reasons, not grounds of cost. The NHS is
there to keep people healthy, not to sit in judgment on individual lifestyles.

A spokesman for NICE said: ‘We want to reassure people not in producing our guidance we
are not going to take into consideration whether or not a particular condition was or is self-inflicted.
The only circumstance where that may be taken into account is where that treatment may be less
effective because of lifestyle choices’.

Jonathan Ellis, the policy manager at Help the Aged, said it was pleased NICE had finally
shown an understanding of the importance of tackling age discrimination. ‘White this is a major feat
there is still some way to go to banish the evident inherent age discrimination that exists within
health care services,’ he said. ‘The NHS now has much to learn. It will ensure it fairer deal all round
for older people using the NHS.’

Questions 1-3: Which THREE of the following statements is true of NICE?

A. It feels that people with bad health habit should not receive treatment.

B. It is an agency that offers advice to the NHS.

C. Some of the reports they produce discriminate against the elderly.

D. It insists its decision should only be applicable in certain situations.

E. It is an agency that controls all NHS policy regarding treatments.

F. It powers are not as extensive as those of the NBS.

G. Many PCTs base their decisions concerning funding on one made by NICE.

H. It has made a statement that overweight people will not receive new joints.

Questions 4-6: Choose the correct letter, A, B, C or D.

4. NICE argues that

A. rich people should not be given special consideration over the poor.
B. only patients with certain diseases should be considered for treatment.

C. social roles should be considered when deciding treatment.

D. cost of treatment would depend on patients’ income.

5. What recommendations has NICE made?

A. to provide older women with IVF treatment

B. to make flu drugs accessible to women under 40

C. to give people between 23-39 flu drugs

D. to allow certain women to have IVF treatments

6. NICE admits that

A. some drugs used by the NHS were not clinically effective.

B. their advice is sometimes ignored by the NHS.

C. it is often hard to determine if a patient has caused his or her condition.

D. they are more concerned about cost-effectiveness than patients.

Questions 7-13: Match each statement with the correct person A-C.

7. This person was happy that NICE realized age discrimination needed dealing with.

8. This person holds a very high position in the NICE agency.

9. This person is a member of a political party.

10. This person says their policy regarding age is precise and easy to understand.

11. This person does not agree with the position taken by NICE.

12. This person feels the NHS must further improve its relations with the elderly.

13. This person says that NICE does not discriminate on the grounds of age.

A. Michael Rawlins

B. Steve Webb
C. Jonathan Ellis