Please answer questions 1-10 with reference to the passage that follows. One and only one response is correct for each question.
1. The title of the article suggests that: a. it is no longer fair to describe certain tropical diseases as ‘neglected’ because huge steps have been taken towards their eradication b. little medical progress has been made, because researchers have neglected to treat diseases in tropical regions c. despite the advances made, there is still much work to be done in the field of neglected tropical diseases d. efforts to confront the challenge of tropical diseases among neglected peoples have been weak 2. ‘Working to overcome the global impact of neglected tropical diseases’ is: a. a noun-phrase that is the object of the verb b. the title of the World Health Organization report that is the main subject of the article c. a quotation from a recently-published article by the same author d. a phrase the author has highlighted to indicate that he/she does not entirely agree with it 3. Paragraph 2 tells us that: a. taken as a group, the 17 diseases covered by the report affect 149 countries around the world b. all the 17 neglected tropical diseases are found in all the 149 countries in which research was carried out c. at least a billion people around the world are living in poverty d. people living in poor countries tend to be affected by all 17 neglected tropical diseases at the same time 4. Which of the following pieces of information CANNOT be deduced from Paragraph 3? a. Albendazole is used to treat lymphatic filariasis b. GSK, Eisai, Novartis, Sanofi-Aventis, and Johnson & Johnson are names of companies donating drugs to help control and or treat tropical diseases c. Eisai is a local African name for lymphatic filariasis d. GlaxoSmithKline’s donations and programmes are now sufficient to treat all African children old enough to go to school for helminthiases found in the soil 5. According to Paragraph 4, a Lancet publication in January 2010 suggested that: a. the percentage of foreign aid earmarked for neglected tropical diseases is highly disproportionate to the scale of the problem b. chemotherapy has prevented helminth infection in 670,000,000 individuals since 2008 c. the drug industry and other agencies have been advocating strenuously for neglected tropical diseases in recent years d. the governments of countries affected by neglected tropical diseases do not number among the World Health Organisation’s strongest partners 6. The words “financing”, ‘increased”, “however”, and “meeting” in Pargraph 5 could be replaced by: a. “discovery”, “racked up”, “but”, and “encountering” b. “budget cuts”, “raised”, “hereby”, and “reaching” c. “funding”, “stepped up”, “nevertheless”, and “attaining” d. “money”, “enhanced”, “thus”, and “reunion” 7. Which of the following phrases best summarises the main argument made in Paragraph 6? a. The imminent eradication of preventable diseases b. The best tools are already in place c. The need for monitoring and evaluation d. Greatly expanded availability of treatment for tropical diseases 8. Which of the following statements is true according to Paragraph 7? a. Guinea-worm could be eradicated in Africa by increasing every individual’s income by 50 US cents b. Margaret Chan is the main author of the WHO report c. The WHO has already made the provision of praziquantel a high priority d. There is still a shortfall of 50% in donations of praziquantel 9. If indicates positive and negative, which of the following lists best describes the vocabulary items highlighted in Paragraph 8: a. neglect , old , drug resistance , expertise , scarce , few b. neglect , old , drug resistance , expertise , scarce , few c. neglect , old , drug resistance , expertise , scarce , few d. neglect , old , drug resistance , expertise , scarce , few 10. The overall tone of the article could best be described as: a. alarmist and pessimistic b. old-fashioned and dismissive c. cautiously positive and forward-looking d. highly technical and very difficult for a non-specialist to understand
Progress and challenges in neglected tropical diseases 1. Substantial progress towards removing the “neglected” from neglected tropical diseases was made last week with the launch of WHO’s first global report on the diseases, coupled with new pledges to donate crucial drugs. 2. Working to overcome the global impact of neglected tropical diseases reviews the strategy to prevent or control the 17 infectious diseases that affect at least a billion poor, underserved people, and analyses key features of their epidemiology and treatment. Together, the 17 diseases are endemic in 149 countries. They include, for example, schistosomiasis, the trypanosomiases, leprosy, trachoma, leishmaniasis, onchocerciasis (river blindness), soil- transmitted helminthiases, dengue, lymphatic filariasis, and dracunculiasis (guinea-worm disease). 3. Huge donor commitments were made at the report’s launch meeting in Geneva on Oct 14, including an increase to a billion tablets per year of albendazole from GlaxoSmithKline (GSK), which is enough to treat every school-aged child in Africa for soil-transmitted helminthiases when added to GSK’s existing lymphatic filariasis albendazole programme. A new donation of diethylcarbamazine for lymphatic filariasis (Eisai), expanded donations for leprosy (Novartis), trypanosomiases, leishmaniasis, and Buruli ulcer (Sanofi -Aventis), and mebendazole for soil- transmitted helminthiases (Johnson & Johnson) were also announced. 4. As outlined in WHO’s report, great progress has been made, with 670 million people having received preventive chemotherapy for helminth infections in 2008. Yet “only 0·6% of overseas development assistance for health is allocated to neglected tropical diseases, despite such diseases affecting at least 1 billion people”, as pointed out in the introduction to a Lancet Series on these diseases in January, 2010. Advocacy for neglected tropical diseases within WHO at the highest level, together with strong leadership from WHO and its partners, including governments of disease-endemic countries, has raised the profile of these diseases, and encouraged the drug industry, and other agencies, to invest in prevention and control. 5. Progress has been made with integration of the prevention and control of neglected tropical diseases into health-care systems in many endemic countries, but challenges remain. Financing at country level needs to be increased, as does the priority accorded to these diseases given their burden and impact. However, meeting Millennium Development Goals, and enacting a more effective pro-poor strategy, requires greater pooling of resources with initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. 6. With more people getting treated, the need to monitor and assess changes in disease epidemiology, transmission, and treatment compliance remains a challenge. Monitoring and evaluation is crucial to modify strategies as needed, and to ensure that the best tools are in place for prevention, control, and even eradication of some diseases. 7. As highlighted by Margaret Chan, WHO’s Director-General, at the report’s launch, “these diseases anchor large numbers of people in poverty”. Although few data for the cost- effectiveness of some treatments exist, there are robust analyses available for ten of the 17 neglected tropical diseases. In fact, for often less than 50 US cents a year per person, morbidity due to seven of these diseases could be greatly reduced in Africa. Guinea-worm disease could be eradicated by 2015. The outstanding major gap in donated drugs is praziquantel for schistosomiasis—only half of what is needed has so far been pledged. WHO,
with the drug industry, should make provision of praziquantel a priority to all school-aged children in need. 8. The effect of 30 years of neglect for these diseases in research and development of new diagnostics and drugs, and, crucially, in investing in training and education in vector-borne diseases, is evident. Most current drugs for neglected tropical diseases are old, and the spectre of drug resistance cannot be ignored. As well as a vaccine for dengue, cases of which have doubled in the past decade, new drugs are urgently needed for leishmaniasis and the trypanosomiases. Expertise in the individual diseases is scarce in many countries, with few degree courses available in entomology or in the study of snails. Without experts, research and development of new approaches to diagnosis and treatment will remain neglected. 9. Much has been achieved in the past decade for these diseases. The next decade needs to see escalating momentum in leadership, prioritisation on health agendas, drug donations (particularly more praziquantel), and research—all to eradicate or control neglected tropical diseases as a major contribution to sustainable development. ■ The Lancet Please answer questions 11-15 with reference to the following text. One and only one response is correct for each question. 11. The phrase “allocative efficiency” in the first paragraph means: a. providing lower quality health care to a broader section of society b. introducing health care management reforms in different countries around the world c. according priority to actions that provide the best value for money d. increasing the net value of private practices 12. According to Paragraph 2, what happened in Brazil in 2003? a. A new government department was set up b. A growing disproportion emerged between the production of scientific research and the application of this to real health-care practice c. A set of health research guidelines were drawn up and approved d. A team of researchers led by R. Guimarães produced a paper on National Health Science Policy 13. Which of the following phrases best summarizes Paragraph 3? a. The financial decline of the SUS b. Researchers and managers working together for health c. Growing up in State Health Care Management d. Conflicts between management and research comes to a head 14. Which of the following graphics best illustrates the statistics presented at the end of Paragraph 4? DECIT-Funded Projects 2003-2009 Research Project Funding 2003-2009 ilia z ra 40 Research Project Funding 2003-2009 DECIT Funded Projects 2003-2009 15. The phrase “These efforts notwithstanding, much remains to be done” in Paragraph 5 could be replaced by: a. “Whatever its strengths, the project is at a standstill at present” b. “Since such attempts have been made, there is nothing left to do” c. “If such attempts do not succeed, the challenge ahead is enormous” d. “Despite such efforts, much work still needs to be carried out” The role of research in the consolidation of the Unified National Health System (SUS)
1. The challenge of providing quality while maintaining costs at affordable levels for society has motivated the implementation of health system reforms in various countries, seeking “allocative efficiency”, namely, prioritizing actions with the best cost-effectiveness ratio. This situation assigns increasing value to the adoption of evidence-based practices and policies. 2. In Brazil, however, there was a persistent mismatch between scientific output and the use of its results in defining health policies and services. The Department of Science and Technology (DECIT), strengthened by the creation of the Secretariat of Science, Technology, and Strategic Inputs under the Ministry of Health in 2003, has contributed to identifying and promoting strategic research for the SUS. The main guidelines for the work by DECIT are provided by the National Agenda for Research Priorities in Health and the National Policy for Science, Technology, and Innovation in Health (PNCTIS), both approved during the 2nd National Thematic Conference in 2004. The Conference included extensive involvement by health researchers, professionals, managers, and users of the National Health System (Guimarães R, et al., Cad Saúde Pública 2006; 22:1775-94). 3. Participation by SUS managers has been crucial for including health problems on the scientific research agenda. An example is the growing participation by State health departments in the management of the Research Program for the SUS, implemented in all States of Brazil financed by DECIT and State Foundations to Support Research. 4. The presence of the DECIT in the national coordination of health research has also allowed Brazil to establish multicenter studies and collaborative networks that require broad dialogue among many stakeholders. The Longitudinal Study on Adult Health (ELSA) and the National Networks for Clinical Research and Cell Therapy are examples of this exercise, demonstrating maturity in the management of health research investments. From 2003 to 2009, DECIT financed more than 3,700 research projects and made available R$650 million in funds, 60% of which from its own budget and the rest from partner institutions. 5. These efforts notwithstanding, much remains to be done. In the current context, perhaps the main challenge is to define an organizational structure to promote technology research and assessment in the SUS, ensuring the continuity and extension of the actions under way. Dealing with this challenge requires participation not only by health managers, professionals, and community representatives of social control in the SUS, but also by members of the scientific community.
Answer Questions 16-20 with reference to the following passage. One and only one response is correct for each question. 16. The first paragraph states that: a. The Brazilian population is methodologically incomparable with those used for studies of SAH in the 1980s and 90s b. A broad variation in prevalence rates of SAH is a prerequisite for robust statistical analysis c. The lack of specific funding of studies in the past 20 years has enabled them to target a broader range of varieties of arterial hypertension d. Despite the shortcomings of studies of SAH in Brazil, such studies nevertheless provided a solid basis for health policy in the final decade of the 20th century 17. According to Paragraph 2: a. Recent studies of hypertension have remained silent regarding the main issues involved b. Both the self-reported data from 2003 and the telephone surveys had serious flaws c. All the subjects covered by the surveys carried out between 2003 and 2008 had consulted a doctor immediately prior to being interviewed d. Patients find it difficult to recall whether they have been diagnosed as hypertensive 18. According to Paragraph 3, the VIGITEL surveys showed that the prevalence of hypertension in Brazil: a. Went up between 2006 and 2007, but remained steady from 2007 to 2008 b. Was at its lowest in 2006 c. Dipped to 21% in 2007, but rose again to 24% in 2008 d. Varied greatly from region to region 19. The phrase “this period” in Paragraph 3 refers to: a. The past 20 years b. 2006-2008 c. 2006 to the present day d. Modern times 20. The article as a whole: a. Identifies a clear trend in the development of the prevalence of hypertension in Brazil over the past few years b. Is proud of the high degree of statistical significance of the results of studies of hypertension carried out recently in Brazil c. Strongly warns against using the results of recent surveys to guide health- care policy d. Suggests that, for the time being, Brazilian health authorities will have to make do with the unreliable data so far made available
Systemic arterial hypertension in Brazil 1. In the past 20 years, a few researchers have produced some scattered information on Systemic Arterial Hypertension in the Brazilian population. The studies were methodologically incomparable, were conducted without specific funding, and reported a wide variation in prevalence rates (from 15% to 43%), but they laid important groundwork for SAH epidemiology in Brazil and contributed to health policies and programs in the late 1980s and early 1990s. 2. The failure of attempts to control SAH through programs that are often poorly administered in the various States finally led to the realization that methodologically standardized and comprehensive data are indispensable for monitoring SAH in the population, from the perspective of successfully controlling the disease. A survey was thus conducted in 2003 on self-reported cancer, hypertension, and diabetes in 16 of Brazil’s 27 capital cities, including not only State capitals but the Federal District or national capital, Brasilia. Three telephone surveys (VIGITEL 2006, 2007, and 2008) were conducted by the Ministry of Health to measure SAH rates, reported according to “medical diagnosis”. However, SAH is silent, and a medical diagnosis implies that the interviewees consulted a physician shortly before the interview and were informed about having versus not having high blood pressure, including their individual pressure levels. The method also requires ruling out at least a dozen different biases related to the research instruments, measurement technique, socio-demographic and socio-medical sample profiles, and participants’ recall, among others. 3. Self-reporting surveys are not the best choice for obtaining information on measurable risk factors, but in the case of SAH they are the only available standardized option for all the capital cities in Brazil, regardless of the social discrepancies. According to the VIGITEL surveys, the SAH prevalence rates for Brazil as a whole were 22% (2006), 21% (2007), and 24% (2008). This period is too short to infer a trend for a non-communicable disease, besides the fact that the data were produced in consecutive years, thus not contributing to the inference of a trend. While we await further results, we should positively consider drawing on the VIGITEL data, making the best possible use of them, as the Ministry of Health is doing.
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