PART I. Answer Questions 1-10 with reference to TEXT 1 that follows. Only one option is correct for each question.

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2 PART I Answer Questions 1-10 with reference to TEXT 1 that follows. Only one option is correct for each question. 1. The title of the text: A. queries how much effort is being spent on containing swine flu B. reflects on the prevalence of influenza in pigs C. questions the extent to which the H1N1 virus is a global threat D. inquires as to the cost of treating swine influenza 2. The first sentence of the first paragraph tells us that: A. no-one knew what caused the level of pandemic to increase and begin infecting humans on 27 April B. the pandemic alert level went up on 27 April, because the new strain of influenza was now being found in humans outside Mexico C. the pandemic alert level was increased on 27 April when a new strain of influenza was first found in humans in Mexico D. the H1N1 virus spread around the world in pigs before reaching Mexico 3. The words concern and mounting in the second sentence of Paragraph 1 could be replaced by: A. apprehension and raising B. preoccupation and riding C. care and climbing D. worry and rising 4. Which of the following pieces of information is given in Paragraph 2? A. On 24 April, Mexican officials crossed one of their own influenza viruses with two from California B. It is very unlikely that there was a surge in human infections in Mexico in mid-march C. The first cases identified by health officials turned out to be seasonal imaginings D. It is very unusual for strains of pig flu to cross to humans. 5. Paragraph 3 describes: A. how the World Health Organization failed to take prompt and adequate measures to contain the spread of the disease. B. how H1N1 swiftly spread from Mexico to the US and then around the world. C. how novel drugs, such as oseltamivir and zanamivir, were rapidly developed and distributed to respond to the outbreak. D. how officials in Mexico and the US and at global level quickly responded to protect the public from the spread of the new virus. 1

3 6. We learn from Paragraph 4 that: A. it is now impossible to stop the spread of H1N1 worldwide. B. it is now unlikely that the spread of H1N1 can be halted in countries where it is already present. C. the way in which the H1N1 virus was spreading suggested that human-to-human infection was no longer taking place. D. panic caused by the virus was beginning to cause unrest in various communities. 7. The word others in the first line of Paragraph 6 probably refers to: A. other countries B. other tasks C. other people D. foreigners 8. Reference is made in Paragraph 6 to: A. a sensationalist book published in 2006 that extrapolated from the evidence of the Spanish Influenza pandemic to predict a catastrophic global outbreak in the near future. B. an article published recently in another periodical which found that 96% of poor people would die in the event of a major outbreak of influenza in low-income communities. C. an article published in previous edition of the periodical which found that the vast majority of mortalities from a major influenza outbreak would occur among the poorer sectors of society. D. Christopher Murray s work on internal migration as an epidemiological factor in the spread of the Spanish Influenza pandemic. 9. The final paragraph: A. attempts to shock members of the public into isolating themselves from the rest of society as the only way of avoiding numbering among the mortalities. B. warns the public that swine influenza will kill more people and advises individuals as to what measures they can take to contain the spread of the virus. C. suggests that, even though members of the public have taken appropriate measures to protect themselves from the virus, it is unlikely that a vaccine will be available in time to prevent widespread mortality. D. advises the public not to take much notice of official recommendations until more is known about the virus and adequate antiviral medication is available. 10. boost stockpiles in the final paragraph means: A. cause a spike in share prices B. speed up throughput C. increase the quantity in storage D. roll out distribution of stock as fast as possible 2

4 TEXT 1 Swine influenza: how much of a global threat? On April 27, WHO raised its pandemic alert level from phase 3 to phase 4 after human cases of a novel H1N1 swine influenza A virus spread quickly around the world from its origin in Mexico. Concern over the virus a hybrid of human, pig, and avian influenza started mounting internationally last week following outbreaks of influenza-like illnesses in Mexico and other countries. As of April 28, according to WHO, Mexico had 26 laboratory confirmed human cases of swine influenza A (H1N1) with seven confirmed deaths. The USA had 40 confirmed cases with no deaths. Elsewhere, there were confirmed cases in Canada, UK, Spain, New Zealand, and Israel. Swine influenza is a porcine respiratory disease that rarely infects humans. From December, 2005 to February, 2009, the USA had 12 cases of human infection with swine influenza. The outbreak in Mexico might have started as early as March 18, when authorities began detecting a surge in influenza-like illnesses in the country. Health officials initially thought they were seeing cases of seasonal influenza. But, on April 21, the US Centers for Disease Control and Prevention reported two isolated cases of a novel swine influenza in California. On April 24, Mexico announced that the same virus had been detected in the country s outbreak of influenza-like illness. The Mexican Government has been swift to implement public health measures to try to contain the outbreak. On April 24, schools, museums, libraries, and theatres were closed in the capital. 6 million face masks were distributed to the public along with health advice to prevent the spread of infection. Public events were cancelled. Meanwhile, the USA declared a public health emergency and prepared for 12 million doses of oseltamivir to be delivered to states from federal stockpiles (the new virus has tested sensitive to oseltamivir and zanamivir). At the global level, WHO activated its 24 h emergency response room on April 24, which allows the agency to be in contact simultaneously with countries, institutions, partners, and relevant health authorities around the world to coordinate the response. The agency also convened an emergency committee to advise the Director-General on the outbreak. The second meeting of that committee recommended raising the influenza pandemic alert level after the epidemiological pattern of the outbreak suggested that human-tohuman transmission was occurring with the ability to cause community-level outbreaks. The world has moved closer towards a pandemic, but it is not yet inevitable. Crucially, containment of the outbreak is no longer feasible and countries should now be preparing to mitigate the effects of the virus on their populations. Over the past 5 years, the international community has been preparing for an influenza pandemic in response to the threat posed by H5N1 avian influenza. National and regional responses to this threat have been variable. Transparency and continued communication between WHO, governments, health officials, the public, and the media, will be critical as the situation with swine influenza evolves. Some countries are more prepared for this task than others. Of particular concern is the ability of low-income and middle-income countries to detect and mitigate the effects of 3

5 this new virus on their populations. History has shown that developing countries are disproportionately affected by an influenza pandemic. In The Lancet in 2006, for example, Christopher Murray and colleagues used data from the Spanish influenza pandemic to predict that the next global influenza pandemic would kill 62 million people, with 96% of those deaths occurring in low-income and middle-income settings. Displaced populations, such as refugees, are especially at risk. The public should expect further deaths from this swine influenza outbreak. The Lancet certainly expects the number of those infected to increase and the spread of infection to expand. Therefore, all recommendations made so far should be seen as provisional. We are passing through an unstable period in this outbreak s evolution. Every member of the public has a part to play in limiting the risk of a full-blown pandemic. Vigilance, and not alarm, is needed, with readiness to self-isolate oneself at home if an influenzalike illness develops. Such home isolation, combined with other measures of social distancing, are most likely to stop the spread of swine influenza. These actions could buy the necessary time to boost stockpiles of antivirals and develop a vaccine against this virus, which will inevitably take months rather than weeks to prepare and distribute. So far, the rapid responses by governments and international agencies have triggered effective mechanisms to protect the public. But the vital role and responsibility of the individual should not be ignored. The Lancet 4

6 PART 2 Answer Questions with reference to TEXT 2 that follows. Only one option is correct for each question. 11. Which of the following statements regarding pandemic alert levels would it be reasonable to deduce from the information given in the first paragraph? A. There is no Phase 7 alert level. B. There has not been a Phase 5 alert since C. Alert level phases are calculated on the basis of mortality rates D. In Phase 5 the disease has not spread significantly on any one continent 12. The question that begins Paragraph 2: A. suggests that the author him- or herself is unsure as to what should be done. B. is an invitation to readers to send in their own suggestions C. is supposed to be answered by the reader, who can find the correct response in the answers section of this text book D. none of the above 13. The words preparedness and call for at the beginning of Paragraph 2 could be replaced by: A. promptness and summon B. readiness and require C. qualification and evoke D. reliability and demand 14. According to Paragraph 2, what is the problem with current plans to contain the virus? A. Measures will be insufficient to contain a virus as easily transmissible as H1N1. B. The plans, designed to counter a more serious threat, could lead to an immoderate reaction, given the actual scale of the danger. C. It is unreasonable to disrupt the logistics of the global economy, however great the risk of the virus. D. The virus currently circulating may not be H5N At this time in line 6 of Paragraph 2 refers to: A. the time of the last global influenza pandemic B. today C. the time of writing of the article D. the Phase 6 alert level 5

7 16. Which of the following lists of adjectives could be used to order an influenza infection on a scale from least to most serious? A. mild severe fatal B. severe mild fatal C. mild chronic fatal D. acute mild severe chronic fatal 17. The words so far, coped and jump in Paragraph 2 could be replaced by A. hitherto got by start B. up to now managed rise C. heretofore recruited surge D. henceforth succeeded increase 18. It can be concluded from Paragraph 3 that: A. the elderly and very young are the only ones at serious risk of dying as a result of contracting the H1N1 virus. B. in some parts of the world, there will be another surge in cases of H1N1 infection, when the weather begins to get colder in the latter part of C. we can confidently predict that the H1N1 virus will not change genetically in the near future. D. developing nations and those located by the sea are at greater risk from the H1N1 virus. 19. a high burden of other diseases in line 4 of Paragraph 3 means: A. elevated treatment costs B. many cases of other diseases C. other diseases that are difficult to diagnose, treat and cure D. a serious obesity problem. 20. The concluding paragraph states that: A. specially-designed national clothing may help lessen the virulence of the disease. B. people in the country should make their own special plans or they could exacerbate the spread of the virus. C. genetic engineering of the virus is the only hope in poorer countries where the effects of the influenza virus will be worse. D. each nation needs to take specifically-designed measures to counter an H1N1 pandemic that is likely to become more serious in the future. 6

8 TEXT 2 Avoiding panic in a pandemic As of June 15, nearly 36,000 people in 76 countries have been infected with influenza A (H1N1) and 163 have died. Last week, WHO raised the pandemic alert level from phase 5 to 6 the highest level officially signifying the start of the first influenza pandemic since Phase 6 means that there are now sustained community level outbreaks of infection in countries in two continents. How should nations respond? Many countries will have pandemic preparedness plans that call for special measures to be introduced at phase 6. The problem with these plans is that they were devised on the basis of a virulent H5N1 avian influenza being the pandemic virus. Phase 6 could trigger border closures, travel restrictions, and other strong measures disproportionate reactions for the less severe H1N1 virus currently circulating. At this time, WHO regards the H1N1 pandemic to be of moderate severity. Most people infected with the H1N1 virus have had mild symptoms and have often recovered rapidly without treatment. The number of severe and fatal cases has been small, and many of these cases have occurred in people with underlying chronic conditions such as asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity. So far, health systems in affected countries have coped and WHO does not expect to see a jump in severe cases or deaths. But while this news calls for a calm response, complacency would be unwise. Severe and fatal infections have occurred in previously healthy young and middle-aged adults. Influenza A (H1N1) poses a particular risk for pregnant women. Developing countries with a high burden of other diseases and weak health systems should expect to see more severe and fatal infections than would developed countries. Some nations could experience a more severe second wave of infection during their winter influenza season. A vaccine against H1N1 will not be ready before September, according to WHO. And, although the pandemic virus seems stable now, it could mutate. Countries should tailor their pandemic plans to the severity of an influenza A (H1N1) outbreak in their populations. But they must also remain vigilant and be prepared for the situation to worsen. The Lancet 7

9 Centro de Pesquisas AGGEU MAGALHÃES Prova de ingles Segunda feira dia 09 de novembro de h00 12h00 DOUTORADO EM SAÚDE PÚBLICA 2010 Nome de candidato: RG de candidato: TEXT 1 TEXT 2 Question Answer Question Answer 1 A B C D 11 A B C D 2 A B C D 12 A B C D 3 A B C D 13 A B C D 4 A B C D 14 A B C D 5 A B C D 15 A B C D 6 A B C D 16 A B C D 7 A B C D 17 A B C D 8 A B C D 18 A B C D 9 A B C D 19 A B C D 10 A B C D 20 A B C D 8

10 Gabarito 1 C 11 A 2 B 12 D 3 D 13 B 4 D 14 B 5 D 15 C 6 B 16 A 7 A 17 B 8 C 18 B 9 B 19 B 10 C 20 D 9

PART I. Answer Questions 1-10 with reference to TEXT 1 that follows. Only one option is correct for each question.

PART I. Answer Questions 1-10 with reference to TEXT 1 that follows. Only one option is correct for each question. PART I Answer Questions 1-10 with reference to TEXT 1 that follows. Only one option is correct for each question. 1. The title of the article: A. suggests that influenza is no longer a major public health