OET READING PARTS B AND C LESSON: REVIEWDURING THIS LESSON

Understood what is required in Parts B and C of the reading exam Practiced ‘reading for purpose’ in Part B Defined and understood complex OET vocabulary Began an OET reading Part C practice exam Set homework/study plan for next week/arranged future lessons

REVIEW

This lesson reviewed how to improve your understanding of the OET reading tasks for Part B and Part C and considered ways in which you can improve your ability to read for detail, which is absolutely crucial in this section of the exam.

In addition to this, we also considered the importance of developing your vocabulary, so that you are able to identify and effective use synonyms.

This workbook will further test and skills and techniques we have practised during the lesson. The best way to pass the OET reading exam is practice.

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ACTIVITY 1

As you discussed with your teacher in the lesson, you have 45 minutes to complete Parts B and C of the Reading exam. This is brilliant as it means that you will not have to rush through the texts, but rather have a chance to gain a deeper understanding of the ideas discussed. Attention to detail in your reading is crucial for these parts of the exam, as the questions are often worded in such a way to challenge you and encourage you to go back to the texts to double check. Read this information about reading for specific information below, and answer the questions to check your understanding.

What is reading for specific information?

Reading for specific information involves understanding what information, or what kind of information, you’re looking for, locating it and then reading the relevant part carefully to get a full and detailed understanding. Sometimes, reading for specific information also involves reading to see if information is contained in a text.

1. What conclusions can be drawn from the final sentence of the paragraph?a. You might need to determine that the text is factually incorrect.b. You might have to determine that the text lacks certain information.c. You might not be able to determine whether the information is there.

Why is reading for specific information important?

In real life, we often only read parts of texts (the parts that provide the information we’re interested in). For example, if you want to know what’s on TV tonight, you won’t look at the programmes listed in the TV listing for earlier in the day. In reading tasks in English exams, time pressure forces candidates to find information quickly so doing this helps in both real life and exam situations.

2. What is suggested about reading tasks in exams?a. The exam rules determine which skills you need to use.b. They require skills not used in normal everyday life.c. They usually give you plenty of time to achieve the task.

How do you read for specific information?

After identifying the information you need, it’s helpful to determine which part of the text it is in. Heading can help with this, as can reading for gist. The main reading skill employed is scanning. This involves moving very quickly over the text, ignoring unknown vocabulary and focusing solely on key words, phrases and ideas. Scanning should enable you to find the specific information. Then read that part more carefully to get a full understanding.

3. Reading for gist can be helpful in

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a. locating a specific word or phrase.b. working out unknown vocabulary.c. finding the general location of an idea.

ACTIVITY 2

This activity will test your abilities to read for specific information. You need to remember to watch out for synonyms, word choice and pay attention to small details to succeed here. You are going to read four texts about food additives. For questions 1–10 below the passages, choose from the articles (A–D). The articles may be chosen more than once.

A Koki Nakamura: nutritionist

Diet is very important to every individual’s health and well-being. I’ve got clients from all walks of life who have different needs and requirements when it comes to the food they eat. Many people believe that if a food label says ‘no fat’ or ‘low in fat’, then it must be healthy. I cannot stress enough how untrue this is. You would think, with the bad reputation fats have got, that a ‘non-fat’ fat would be ideal. Fake fats contain no fat, no calories and no cholesterol, but they come at another price. These food additives prevent vitamins A, E and D from being absorbed into the body. Such substances are thought to keep the immune system healthy and prevent some cancers. Fake fats are also responsible for digestive problems if people consume too many of them.

B Lynne Davis: food scientist

Food additives are not manufactured solely by the chemical industry, since a number of common additives are extracted from naturally-occurring substances. The best known additives are preservatives, colours and flavours, but many others are commonly used, such as antioxidants, thickeners and sweeteners. Some of these additives are essential in our modern world. Without preservatives, food would go off quickly and that would result in a lot of waste. Scientists don’t just add chemicals to food without researching the substances first. Every constituent of processed food is tested before it is used. There are also tight food regulations all over the world which control the use of additives. There are a few bad apples out there who add dangerous toxins to their foods without testing them thoroughly, but I know that the world’s ever-increasing population dictates that we have to find ways to make our food resources go further and last longer.

C Ivan Mendes: food historian

People have been enhancing their food with naturally available flavourings, preservatives and colours for centuries, but there has been an increasing use of food additives since the 19th century. Since the 1980s, additives are required to be identified on food labels. The use

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of these labels and nutrition facts on food products has opened the food industry to more public scrutiny. As a result, the production of processed foods in particular has become a matter of controversy. Many people have become so sceptical of additives that they do not recognise the potential health benefits. In the 1940s, for example, calcium was added to flour to prevent rickets, a disease that causes the softening of bones in children. Other examples include antioxidants being used to prevent the fat in meats going rancid and the use of fluoride in public water supplies to reduce tooth decay.

D Jyoti Sharma: food safety officer

There has been significant controversy associated with the risks and benefits of food additives. Some artificial food additives have been linked to cancer, digestive problems, neurological conditions, heart disease, obesity and even hyperactivity in children. People are less inclined to question natural additives which have been found to be similarly harmful. They can also be the cause of allergic reactions in certain individuals. However, what food additives do to the food itself is what many people fail to consider. Many of the constituents that you read about on the food and nutrition labels are absolutely essential to commercial food preparation and storage. The job of a food safety officer would be much harder if food went off quickly. Food-borne illnesses and epidemics would not only become more widespread, they would become almost impossible to pinpoint and eliminate. There’s no doubt in my mind that additives are more beneficial than they are harmful.

Questions

Which person says…

1. that manmade additives could cause behavioural problems? ……………

2. describes an additive that can stop important substances being digested? ……………

3. mentions an additive that influences dental hygiene? ……………

4. admits that foods can contain under-researched and poisonous additives? ……………

5. recognises that additives can prevent large-scale outbreaks of disease? ……………

6. states that we have to use additives as a result of overpopulation? ……………

7. mentions that different types of people need to eat different foods? ……………

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8. states that food additives were used in the pre-modern era? ……………

9. says that manufacturers are more closely observed as a result of information on food

packaging? ……………

10. states that all ingredients are examined before they are sold? ……………

ACTIVITY 3

In Part C of the Reading exam, you will need to be able to follow a longer passage of text, recognising how ideas link together and how the discussion builds from an introduction to the conclusion. You will come across lots of different pieces of information within a single passage, and recognising how topics connect together is a very important skill. In this activity, you will need to read this article from the NHS regarding coronary angioplasty and stent insertion. At the end of the article, there are a number of statements regarding information from the text. You will need to study the text closely to work out the order in which this information appears.

Coronary angioplasty and stent insertion

OverviewA coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries (the main blood vessels supplying the heart).

The term "angioplasty" means using a balloon to stretch open a narrowed or blocked artery. However, most modern angioplasty procedures also involve inserting a short wire-mesh tube, called a stent, into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely.

Coronary angioplasty is sometimes known as percutaneous transluminal coronary angioplasty (PTCA). The combination of coronary angioplasty with stenting is usually referred to as percutaneous coronary intervention (PCI).

When a coronary angioplasty is usedLike all organs in the body, the heart needs a constant supply of blood. This is supplied by the coronary arteries.

In older people, these arteries can become narrowed and hardened (known as atherosclerosis), which can cause coronary heart disease.

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If the flow of blood to the heart becomes restricted, it can lead to chest pain known as angina, which is usually triggered by physical activity or stress.

While angina can often be treated with medication, a coronary angioplasty may be required to restore the blood supply to the heart in severe cases where medication is ineffective.

Coronary angioplasties are also often used as an emergency treatment after a heart attack.

What are the benefits of a coronary angioplasty?In most cases, the blood flow through the coronary arteries improves after an angioplasty. Many people find their symptoms get significantly better and they’re able to do more than they could before the procedure.

If you've had a heart attack, an angioplasty can increase your chances of surviving more than clot-busting medication (thrombolysis). The procedure can also reduce your chances of having another heart attack in the future.

How a coronary angioplasty is performedA coronary angioplasty is performed using local anaesthetic, which means you'll be awake while the procedure is carried out.

A thin flexible tube called a catheter will be inserted into one of your arteries through an incision in your groin, wrist or arm. This is guided to the affected coronary artery using an X-ray video.

When the catheter is in place, a thin wire is guided down the length of the affected coronary artery, delivering a small balloon to the affected section of artery. This is then inflated to widen the artery, squashing fatty deposits against the artery wall so blood can flow through it more freely when the deflated balloon is removed.

If a stent is being used, this will be around the balloon before it's inserted. The stent will expand when the balloon is inflated and remains in place when the balloon is deflated and removed.

A coronary angioplasty usually takes between 30 minutes and two hours. If you're being treated for angina, you'll normally be able to go home later the same day or the day after you have the procedure. You'll need to avoid heavy lifting, strenuous activities and driving for at least a week.

If you've been admitted to hospital following a heart attack, you may need to stay in hospital for several days after the angioplasty procedure before going home.

How safe is a coronary angioplasty?

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A coronary angioplasty is one of the most common types of treatment for the heart. Around 75,000 procedures are performed in England each year.

Coronary angioplasties are most commonly performed in people aged 65 or older, as they're more likely to have heart disease.

As the procedure doesn't involve making major incisions in the body, it's usually carried out safely in most people. Doctors refer to this as a minimally invasive form of treatment.

The risk of serious complications from a coronary angioplasty is generally small, but this depends on factors such as:

your age your general health whether you've had a heart attack

Serious problems that can occur as a result of the procedure include excessive bleeding, a heart attack and a stroke.

Are there any alternatives?If many coronary arteries have become blocked and narrowed, or the structure of your arteries is abnormal, a coronary artery bypass graft may be considered.

This is a type of invasive surgery where sections of healthy blood vessel are taken from other parts of the body and attached to the coronary arteries. Blood is diverted through these vessels, so it bypasses the narrowed or clogged parts of the arteries.

Questions

The sentences A – J describe information that can be found in the passage above. Using the numbers 1 – 10, identify the order in which the information appears in the text:

A. angioplasty can lead to excessive bleeding, heart attack and stroke ……………

B. angina is usually triggered by physical activity of stress ……………

C. the angioplasty will take between 30 minutes and two hours ……………

D. stents will be left in permanently to enable freer blood flow ……………

E. around 75,000 coronary angioplasty operations occur each year ……………

F. the procedure can increase the chances of surviving a heart attack ……………

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G. an alternative to angioplasty is a coronary artery bypass graft ……………

H. a person with poorer general health is more at risk of complications ……………

I. the catheter will be inserted through a cut in the groin, wrist or arm ……………

J. following angioplasty, patients should avoid heavy lifting for a week ……………

ACTIVITY 4

Developing your vocabulary so that you are able to use a wide range of words accurately and effectively is central to your success in OET Reading. It is particularly important that you develop your knowledge of healthcare-related terminology, as not recognising basic terms could impact on both your grade in the exam and your practice when you register as a nurse or doctor. Have a go at this crossword to test your medical vocabulary and identify where you might need to undertake some further learning:

Medical Vocabulary

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Across

1. reviving a person and returning them to consciousness2. occurring or existing before birth3. keep an eye on; keep under surveillance4. a person who requires medical care5. a drug that causes temporary loss of bodily sensations6. beyond normal limits7. of or relating to or characterized by fever

Down

1. a bit of tissue or fluid taken for diagnostic purposes2. identifying the nature or cause of some phenomenon3. stopping something from happening in the future4. the region of the body between the thorax and the pelvis5. something that projects from its surroundings6. observe, check out, and look over carefully or inspect7. a disturbance of normal functioning8. not dangerous to health; not recurrent or progressive9. inflammation of a joint or joints10. hypersensitive immunological reaction to some substance11. a deficiency of red blood cells12. respiratory disorder characterized by wheezing

ACTIVITY 5

Facts and opinions are often uttered in the same breath; the terms have a huge difference in their meanings. Whether a statement is a fact or an opinion depends on the validity of the statement. While a fact refers to the something true or real, which is backed by evidence, documentation, etc. On the other hand, opinion is what a person believes or thinks about something. In the OET Reading Exam for Parts B and C, you will need to be able to distinguish between opinion and fact in order to ensure that you are answering multiple choice questions correctly. We will talk a little bit about the differences between opinion and fact before completing an activity which tests this knowledge.

The difference between fact and opinion can be summarised as follows:

1. The fact is described as the statement that can be verified or proved to be true. Opinion is an expression of judgment or belief about something.

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2. Fact relies on observation or research while opinion is based on assumption.

3. The fact is an objective reality whereas opinion is a subjective statement.

4. Facts can be verified with the help of evidence or statistics. On the contrary, opinion is not supported by any evidence.

5. Facts explain what actually happened. Unlike an opinion, that represents a perception about something.

6. One important feature of the fact is that it is universal and does not differ from person to person. As against this, every human being has a different opinion on a particular subject and so, it varies from one person to another.

7. Facts are shown with unbiased words, however, opinion is expressed with biased words.

8. Facts can change anybody’s opinion, but vice versa is not possible.

9. Facts are real information and so it cannot be challenged or debated, but if we talk about opinions, they can be debated.

Now, try the following activity. Read the article below. At the end of the passage are excerpts from the article; you will need to decide whether they are examples of fact or opinion…

What does the NHS need to survive for another 70 years?

As the health service marks its 70th anniversary, experts offer their prescriptions for keeping it going

Richard Horton: Ever greater injections of cash aren’t the answer

It’s not (only) about the money. The idea that the NHS can be fixed by ever greater injections of cash is a fantasy advanced by those with their own interests to protect. The UK is 23rd in the latest league table of countries ranked according to access and quality of healthcare. That fact alone should persuade politicians to demand serious reforms of the NHS in exchange for investments, not merely prop up a struggling and outdated health system.

What should be done? First, end the hierarchical referral model of primary to secondary care, which is increasingly inefficient and ineffective. GPs and specialists should be working side by side in the community. Second, target disparities. The broader social determinants of health – poverty, poor housing, eroded education, degraded environments, lack of attention to early child development – have long been ignored by all governments. They must be prioritised. Third, upgrade the quality of the health workforce. Learning must be lifelong, focused on skills not credentials, and adapted to local needs.

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Finally, stop thinking of the NHS as a cost. The NHS is an engine of growth, protecting our economy in hard times and strengthening wealth creation always, through improved labour supplies, social cohesion and health security. The NHS may be a national religion. But it is a religion in need of a reformation.

• Richard Horton is editor of The Lancet

Clare Gerada: Rebuild the GP workforce

The Chinese government is planning to train 500,000 GPs over the next 12 years. It realises, as many other countries do, that the only way to create a sustainable, affordable, accessible and high-quality health system is to invest in general practice. Regardless of whether your system is publicly or privately funded, the health needs of increasingly ageing populations can be met only by putting skilled GPs at its front door.

GPs work at the interface between illness and disease. They manage risk and uncertainty; they help coordinate care for the growing number of patients with complex health needs. Despite the proven worth of general practice, in our own NHS it is under threat. Primarily, this is due to decades of underfunding coupled with more and more care being moved out of the hospital without simultaneous shift of investment. The challenge for the survival of the NHS is to refocus our resources to where they are needed most – that is general practice and community care. We have to rebuild our GP workforce, and in so doing ensure that GPs are able to do what they do best: provide continuity of care to patients in the context of their families and communities. If we do this, everything else we want to do in the health service will be achievable. Without it, all else will fail.

• Clare Gerada is former chair of the Royal College of General Practitioners

Rachel Clarke: Community services are key

As mortifying moments in medicine go, the way one elderly man crumpled into tears of relief and gratitude would have shamed the most hardened of doctors. A former army officer, now pared to the bone by cancer, he visibly hated exhibiting weakness. But for months, with his pain becoming unbearable, the lack of district nurses, GPs and carers locally had reduced a proud, upright man to abject misery.

As I admitted him into my NHS hospice, I was struck yet again by the poignancy of the fact that only one in five of us will die at home, despite two-thirds of us wishing to do so. This cannot, surely, be right. If ever a measure of decency counts, it is how a society treats its terminally ill members.

The NHS is in desperate need of properly beefed-up community services. Not the rhetorical kind beloved of government press releases, but real – and massive – expansion of community staffing to keep patients at home for as long as they desire. Since 2010, underfunding has culled half our district nurses, for example – a terrible false economy. We need to reverse that, urgently, to prevent patients being driven unnecessarily into hospital by appallingly threadbare community services.

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• Rachel Clarke is a palliative care doctor

Bob Kerslake: Lansley’s reforms were a disaster. Scrap them

The greatest strength of the NHS is that the public believe in it. It follows that its greatest risk is that, through inadequate finance and political ineptitude, the public lose confidence in its founding principles – care that is free at the point of delivery, based on need, and funded by central taxation.

We now, at last, seem to be moving away from the period of denial on funding, but its future is still not secure. For that we need a dedicated funding stream (a repurposed national insurance), and an independent body to assess current and future needs, and resolution of the social care funding crisis.

Beyond this, we need to recognise the changes brought in by the 2012 Health and Social Care Act as the disaster that they were and have the courage to change them. This should include drastically simplifying the national bodies, removing the “any willing provider” provision, devolving decision-making, giving greater voice to those who work in the NHS, and establishing a credible long-term investment strategy. We need a decisive move away from the top-down command and control culture that the financial crisis has reinforced.

Technological changes will transform the way we deliver healthcare. We can all live healthier lives. There are grounds for real optimism. But first we need to put the NHS on a sound financial and management footing.

• Bob Kerslake is a former head of the civil service and chair of King’s College Hospital NHS Foundation Trust

Questions

1. ‘Regardless of whether your system is publicly or privately funded, the health needs

of increasingly ageing populations can be met only by putting skilled GPs at its front

door.’

Fact/Opinion

2. ‘Lansley’s reforms were a disaster. Scrap them.’

Fact/Opinion

3. ‘Richard Horton is editor of The Lancet.’

Fact/Opinion

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4. ‘Learning must be lifelong, focused on skills not credentials, and adapted to local

needs.’

Fact/Opinion

5. ‘We need a decisive move away from the top-down command and control culture

that the financial crisis has reinforced.’

Fact/Opinion

6. ‘The NHS is in desperate need of properly beefed-up community services.’

Fact/Opinion

7. ‘… only one in five of us will die at home, despite two-thirds of us wishing to do so.’

Fact/Opinion

8. ‘The Chinese government is planning to train 500,000 GPs over the next 12 years.’

Fact/Opinion

9. ‘If we do this, everything else we want to do in the health service will be achievable.’

Fact/Opinion

10. ‘The greatest strength of the NHS is that the public believe in it.’

Fact/Opinion

11. ‘The UK is 23rd in the latest league table of countries ranked according to access and

quality of healthcare.’

Fact/Opinion

12. ‘Bob Kerslake is a former head of the civil service and chair of King’s College Hospital

NHS Foundation Trust.’

Fact/Opinion

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PRACTICE TEST

PART B

In this part of the test, there are four short extracts relating to the work of health professionals. For questions 1 – 4, choose answer (A, B or C) which you think fits best according to the text.

From: Safeguarding children and young people: roles and competences for health care staff (2014)Different staff groups require different levels of competence depending on their role and degree of contact with children, young people and families, the nature of their work, and their level of responsibility All staff working in a health care setting must know what to do if there is a child protection concern involving a child or family, know the referral procedure, which includes knowing whom to contact within their organisation to communicate their concerns. In response to the Laming Report and other evidence such as serious case reviews, there has been recognition of the importance of the level of competence of some practitioner groups, for example GPs and paediatricians.

1. These guidelines inform us thatA. All staff must undertake the same training regarding safeguarding children

and young people.B. Evidence has found that it is particularly important that GPs and

paediatricians possess good skills in safeguarding.C. The referral procedure involves staff knowing which external organisations to

contact with concerns.

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Titan Ultrasound System User GuideCaliper Placement

When making a measurement, accurate placement of the caliper is essential.To improve caliper placement precision: adjust the display for maximum sharpness; use leading edges (closest to the transducer) or borders for start and stop points; and maintain a constant transducer orientation for each type of measurement.When the calipers are positioned farther apart, they get larger. When the calipers are moved closer together, they get smaller. The caliper line disappears as the calipers get closer together.

2. This instruction manual is clear thatA. Changing the display makes it easier to place the calipers more precisely.B. When the calipers are moved closer together, the caliper line grows.C. The placement of the calipers is not important for ascertaining volume.

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NHS Scotland Briefing Paper: Interventions to reduce alcohol consumption during pregnancyThere is limited evidence about what works to reduce alcohol consumption during pregnancy. Currently, psychological and educational interventions such as brief advice and motivational-based techniques show most promise. The inconsistency in results, the paucity of studies, the number of participants, the high risk of study bias and the complexity of interventions limit the ability to determine the type of intervention that would be most effective in increasing abstinence from, or reducing the consumption of alcohol among pregnant women. These limitations highlight the need for further robust studies in this area.

3. Based on the conclusion of this briefing paper, healthcare professionals working with pregnant women shouldA. Avoid discussing alcohol consumption with women during pregnancy as it is not

known how best to approach the issue.B. Consider undertaking interventions which intrinsically consider a patient’s

motivation.C. Undertake research with their patients who want to reduce their alcohol

consumption.

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Patient Safety MemoBaljit Sahota, Principal Pharmacist, Quality and Safety, King George Hospital

To ensure medicines are safe to be administered, they must be stored at the right temperature. If they are stored incorrectly they may not work in the way they were intended which could pose a potential risk to the health and wellbeing of our patents. Nursing staff and departmental leads should be monitoring the fridges daily to ensure that they are working properly, and I regularly audit the temperature logs in my clinical areas to check that medicines are being kept properly.

Controlled drugs are bound by legislation to make sure that they are securely stored, stock levels are correct, and each administration is accurately and clearly recorded. Pharmacists monitor controlled drugs every three months to check stock balances and check that all entries in the controlled drug record book are legally correct and legible.

All medicines on our wards and in our departments need to be stored safely and securely and we all have a role to play in that.

4. This patient safety memo advises that A. If fridges are not working properly, this could impact on the efficacy and safety of

medication for a patient. B. Staff must ensure that all medicines are stored at the temperature explicitly

stipulated in the legislation.C. Keeping medicines in a locked cabinet is preferable to storing them in a fridge as

security is very important .

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Patient Handover: Mr Abdul ZariffBed 10 is Mr Abdul Zariff. He's a 60 yr -old male who was admitted from Emerg with a query bowel obstruction. He's had bowel cancer 3 years ago, and that was resected. This admission they are querying whether he has adhesions or a stricture at the operation site. His T is 37.8; his P is 80; resps are 25, and BP is 150/ 90. He's highly anxious and he thinks that the cancer has re-occurred. He's got an N/G tube on low-pressure suction to manage the nausea and vomiting. IVT of N/saline at 125 mls/hr, with next bag to have next flask to have KCl added – see the orders for that. His skin turgour indicated he was quite dry (but his skin is intact). Oral mucosa is very dry, so offer mouth care. And his wife will be in later this afternoon to speak with the Dr.

5. Based on these handover notes, the next nurse caring for Mr Zariff shouldA. Inform the patient’s wife that Mr Zariff has a bowel obstruction.B. Offer the patient painkillers as requested.C. Ensure that the patient is reassured to manage his emotional wellbeing.

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SUTURE PREPARATION IN THE STERILE FIELDSuture preparation may be more confusing than virtually any other aspect of case preparation. Familiarity and understanding of the sequence in which tissue layers are handled by the surgeon will help to eliminate this confusion. (See the Suturing Section, Chapter 2.)

Once the suture packets are opened and prepared according to the surgeon's preference card, sutures can be organized in the sequence in which the surgeon will use them. Ligatures (ties) are often used first in subcutaneous tissue shortly after the incision is made, unless ligating clips or an electrosurgical cautery device is used to coagulate severed blood vessels.

6. Suture preparation involvesA. Clarity regarding the order of tissue layers.B. Ensuring that the electrosurgical cautery device has been deployed in advance.C. The surgeon stating the level of absorbance of sutures he requires.

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PART C

Instructions

TIME LIMIT: 45 MINUTES (including Part B also)

There are TWO reading texts in Part C. You should read and answer the questions for one at a time. After each of the texts you will find a number of questions or unfinished statements about the text, each with four suggested answers or ways of finishing.

You must choose the ONE which you think fits best. For each question indicate on your answer sheet the letter A, B, C or D against the number of the question. Only your answers on the Answer Sheet will be marked during a real OET exam.

Answer ALL questions. Marks are NOT deducted for incorrect answers.

Text C1

Going blind in Australia

Australians are living longer and so face increasing levels of visual impairment. When we look at the problem of visual impairment and the elderly, there are three main issues. First, most impaired people retire with relatively “normal” eyesight, with no more than presbyopia, which is common in most people over 45 years of age. Second, those with visual impairment do have eye disease and are not merely suffering from “old age”. Third, almost all the major ocular disorders affecting the older population, such as cataract, glaucoma and age-related macular degeneration (AMD), are progressive and if untreated will cause visual impairment and eventual blindness.

Cataract accounts for nearly half of all blindness and remains the most prevalent cause of blindness worldwide. In Australia, we do not know how prevalent cataract is, but it was estimated in 1979 to affect the vision of 43 persons per thousand over the age of 64 years. Although some risk factors for cataract have been identified, such as ultraviolet radiation, cigarette smoking and alcohol consumption, there is no proven means of preventing the development of most age-related or senile cataract. However cataract blindness can be delayed or cured if diagnosis is early and therapy, including surgery, is accessible.

AMD is the leading cause of new cases of blindness in those over 65. In the United States, it affects 8–11% of those aged 65–74, and 20% of those over 75 years. In Australia, the prevalence of AMD is presently unknown but could be similar to that in the USA. Unlike cataract, the treatment possibilities for AMD are limited. Glaucoma is the third major cause of vision loss in the elderly. This insidious disease is often undetected until optic nerve damage is far advanced. While risk factors for glaucoma, such as ethnicity and family history, are known, these associations are poorly understood. With early detection, glaucoma can be controlled medically or surgically.

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While older people use a large percentage of eye services, many more may not have access to, or may underutilise, these services. In the United States, 33% of the elderly in Baltimore had ocular pathology requiring further investigation or intervention. In the UK, only half the visually impaired in London were known by their doctors to have visual problems, and 40% of those visually impaired in the city of Canterbury had never visited an ophthalmologist. The reasons for people underutilising eye care services are, first, that many elderly people believe that poor vision is inevitable or untreatable. Second, many of the visually impaired have other chronic disease and may neglect their eyesight. Third, hospital resources and rehabilitation centres in the community are limited and, finally, social factors play a role.

People in lower socioeconomic groups are more likely to delay seeking treatment; they also use fewer preventive, early intervention and screening services, and fewer rehabilitation and after-care services. The poor use more health services, but their use is episodic, and often involves hospital casualty departments or general medical services, where eyes are not routinely examined. In addition, the costs of services are a great deterrent for those with lower incomes, who are less likely to have private health insurance. For example, surgery is the most effective means of treatment for cataract, and timely medical care is required for glaucoma and AMD. However, in December 1991, the proportion of the Australian population covered by private health insurance was 42%. Less than 38% had supplementary insurance cover. With 46% of category 1 (urgent) patients waiting for more than 30 days for elective eye surgery in the public system, and 54% of category 2 (semi-urgent) patients waiting for more than three months, cost appears to be a barrier to appropriate and adequate care.

With the proportion of Australians aged 65 years and older expected to double from the present 11% to 21% by 2031, the cost to individuals and to society of poor sight will increase significantly if people do not have access to, or do not use, eye services. To help contain these costs, general practitioners can actively investigate the vision of all their older patients, refer them earlier, and teach them self-care practices. In addition, the government, which is responsible to the taxpayer, must provide everyone with equal access to eye health care services. This may not be achieved merely by increasing expenditure – funds need to be directed towards prevention and health promotion, as well as treatment. Such strategies will make good economic sense if they stop older people going blind.

QUESTIONS

1 In paragraph 1, the author suggests that ……

A many people have poor eyesight at retirement age. B sight problems of the aged are often treatable. C cataract and glaucoma are the inevitable results of growing older. D few sight problems of the elderly are potentially damaging.

2 According to paragraph 2, cataracts ……

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A may affect about half the population of Australians aged over 64. B may occur in about 4–5% of Australians aged over 64. C are directly related to smoking and alcohol consumption in old age. D are the cause of more than 50% of visual impairments.

3 According to paragraph 3, age-related macular degeneration (AMD) ……

A responds well to early treatment. B affects 1 in 5 of people aged 65–74. C is a new disease which originated in the USA. D causes a significant amount of sight loss in the elderly.

4 According to paragraph 3, the detection of glaucoma ……

A generally occurs too late for treatment to be effective. B is strongly associated with ethnic and genetic factors. C must occur early to enable effective treatment. D generally occurs before optic nerve damage is very advanced.

5 Statistics in paragraph 4 indicate that ……

A existing eye care services are not fully utilised by the elderly. B GPs are generally aware of their patients’ sight difficulties. C most of the elderly in the USA receive adequate eye treatment. D only 40% of the visually impaired visit an ophthalmologist.

6 According to paragraph 4, which one of the following statements is NOT true?

A Many elderly people believe that eyesight problems cannot be treated effectively.B Elderly people with chronic diseases are more likely to have poor eyesight. C The facilities for eye treatments are not always readily available. D Many elderly people think that deterioration of eyesight is a product of ageing.

7 In discussing social factors affecting the use of health services in paragraph 5, the author points out that ……

A wealthier people use health services more often than poorer people. B poorer people use health services more regularly than wealthier people. C poorer people deliberately avoid having their eye sight examined. D poorer people have less access to the range of available eye care services.

8 According to paragraph 6, in Australia in the year 2031 ……

A about one tenth of the country’s population will be elderly. B about one third of the country’s population will be elderly. C the proportion of people over 65 will be twice the present proportion. D the number of visually impaired will be twice the present number.

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TEXT C2

Sleep apnea

Studies have shown that sleep is essential for normal immune system function and to maintain the ability to fight disease and sickness. Sleep is also essential for normal nervous system function and the ability to function both physically and mentally. In addition, sleep is vital for learning and for normal, healthy cell growth. Despite sleep’s huge importance to people’s lives, scientists and medical professions do not fully understand this complicated physiological phenomenon.

It is not clear exactly why the body requires sleep, although inadequate sleep, including disorders such as lack of sleep (e.g., insomnia) or disturbed sleep (e.g., sleep apnea), can have severe detrimental effects on health. Insomnia is defined as the perception or complaint of inadequate or poor-quality sleep in the form of difficulty falling asleep, difficulty maintaining sleep, or waking too early in the morning. Sleep apnea is interrupted breathing during sleep. It usually occurs because of a mechanical problem in the windpipe but can also indicate a neurological disorder involving nerve cells (neurons). There are three distinct forms of sleep apnea – central, obstructive and complex – with over 80% of cases diagnosed as obstructive sleep apnea, where breathing is interrupted by a physical block of airflow despite the body’s efforts to breath normally. Central sleep apnea, on the other hand, is a much rarer condition caused primarily by problems with how the brain controls the breathing process. In mixed sleep apnea, which accounts for above 15% of apnea cases, there is a transition from central to obstructive features during the events themselves.

Most patients with sleep apnea lose sleep because every time the windpipe closes, the person has to wake up enough to contract those muscles and resume breathing. As a result, the sleep cycle can be interrupted as many as a hundred times a night. In addition, every time the windpipe closes, the brain is deprived of oxygen. This lack of oxygen can eventually cause problems such as daytime sleepiness, morning headaches and decreased mental function.

Sleep apnea also has a strong association with heart and circulation diseases. While the nature of the links is not yet fully clear, researchers know that when breathing stops during episodes of apnea, carbon dioxide levels in the blood increase and oxygen levels drop. This effect may set off a chain of physical and chemical events that can then increase risk for these conditions.

A number of studies have found a strong association between sleep apnea and high blood pressure (hypertension). For example, a 2000 study followed patients for four years and reported that the greater the number of nightly apnea episodes that had in year one, the more likely they were to develop hypertension by the fourth year. A weak but still higher than normal association with high blood pressure has even been observed in those who

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snore, wake frequently during the night, or have mild sleep apnea. The relationship between sleep apnea and hypertension has been thought to be largely due to obesity, a risk factory common to both conditions. Recent and major studies, however, are suggesting a higher rate of hypertension in people with sleep apnea regardless of weight. In those whose hypertension is resistant to treatment, sleep apnea is likely to be particularly severe.

Studies have also reported an association between severe apnea and psychological problems. In one study, 32% of patients had symptoms of depression. Sleep-related breathing disorders can also exacerbate nightmares and post-traumatic stress disorder. In fact, in one study, treatment of sleep apnea eased these complaints. Certainly, daytime sleepiness interferes with quality of life. It is also possible that severe emotional problems might worsen the apnea. One study investigated the effects of the antidepressant paroxetine (Paxil) on patients with obstructive sleep apnea and found that the agent improved breathing during late sleep stages but had little effect on other aspects of the condition.

Because sleep apnea so often includes noisy snoring, the condition can also adversely affect the sleep quality of a patient’s bed partner. Spouses or partners may also suffer from sleeplessness and fatigue. In some cases, the snoring can even disrupt relationships. Diagnosis and treatment of sleep apnea in the patient can, of course, help eliminate these problems, and given the amount of time that the average person spends asleep, it is imperative that work to better understand sleep’s functions and effects continues.

QUESTIONS

1. The word ‘phenomenon’ in paragraph 1 could be best replaced by ….

A result.B problem.C factor.D activity.

2. Obstructive sleep apnea..

A is mechanical and neurological in origin.B accounts for a minority of cases of sleep apnea.C occurs before central sleep apnea.D can occur with central sleep apnea.

3. Central sleep apnea accounts for what percentage of sleep apnea sufferers?

A 80%.B Roughly 15%C 5%

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D Less than 5%

4. According to paragraph 3, the closure of the windpipe…

A contracts musclesB can happen a hundred times in a night.C restarts the breathing process.D also occurs in the daytime.

5. According to paragraph 5, hypertension is considered to be…

A a possible cause of obesity.B a more influential factory in sleep apnea than obesity is.C a cause of sleep apnea rather than of obesity.D resistant to treatment of sleep apnea.

6. The phrase ‘regardless’ of in paragraph 5 means…

A instead of.B resulting from.C and also.D unrelated to.

7. According to paragraph 6, certain antidepressants may…

A alleviate respiratory problems.B have little effect when the patient has sleep apnea.C interfere with the treatment for sleep apnea.D aggravate symptoms of sleep apnea.

8. According to information in paragraph 6, which one of the following statements is TRUE?

A Sleep apnea affects almost a third of depression sufferers.B Sleep apnea episodes may be triggered by nightmares.C Sleep apnea can intensify post-traumatic stress disorder.D Sleep apnea can sometimes be cured for antidepressants.

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ANSWERS

ACTIVITY 1

1. B2. A3. C

ACTIVITY 2

1. D

2. A

3. C

4. B

5. D

6. B

7. A

8. C

9. C

10. B

ACTIVITY 3

A. 9

B. 2

C. 6

D. 1

E. 7

F. 3

G. 10

H. 8

I. 4

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J. 5

ACTIVITY 4

Across

1. resuscitation2. prenatal3. supervise4. patient5. anaesthetic6. excessive7. febrile

Down

1. specimen2. diagnosis3. prevention4. abdomen5. prominence6. examine7. disorder8. benign9. arthritis10. allergy11. anemia12. asthma

ACTIVITY 5

1. Opinion2. Opinion3. Fact4. Opinion5. Opinion6. Opinion7. Fact8. Fact9. Opinion10. Opinion11. Fact

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12. Fact

PRACTICE TEST

Part B

1. B2. A3. B4. A5. C6. A

Text C1

1 B sight problems of the aged are often treatable.

2 B may occur in about 4–5% of Australians aged over 64.

3 D causes a significant amount of sight loss in the elderly.

4 C must occur early to enable effective treatment.

5 A existing eye care services are not fully utilised by the elderly.

6 B Elderly people with chronic diseases are more likely to have poor eyesight.

7 D poorer people have less access to the range of available eye care services.

8 C the proportion of people over 65 will be twice the present proportion.

Text C2

1 D activity

2 D can occur with central sleep apnea.

3 D less than 5%.

4 B can happen a hundred times in a night.

5 B a more influential factory in sleep apnea than obesity is.

6 D unrelated to.

7 A alleviate respiratory problems.

8 C Sleep apnea can intensify post-traumatic stress disorder.

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