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 problem B. questions whether anyone really cares about contracting the H1N1 virus C. implies that no-one knows who is responsible for the spread of influenza D. makes reference to the efforts being made by the World Health Organisation to control influenza 2. Which of the following pieces of information is NOT to be found in the second paragraph? A. A long-term strategy for bringing down the numbers of people who become sick and die as a result of influenza has yet to be developed. B. There were four worldwide outbreaks of influenza in the 20 th century, which killed over 50,000,000 individuals. C. The elderly with a current population of more than 380,000,000 are more likely to die as a result of contracting influenza. D. A very large number of people around the world especially in poorer countries have not heard of the influenza vaccine or are unable to obtain it. 3. The word milestone in the first sentence of the third paragraph suggests that the Global Agenda on Influenza: A. is still far from achieving its goals B. is only a preliminary step towards containing this disease C. may prove to be a crucial step towards containing the disease D. aims to achieve its goals by way of roadside vaccination centres 4. The stakeholders referred to in line 4 of paragraph 3 are: A. people who own shares in pharmaceutical companies B. people from various sectors of society with an interest in influenza C. people who have staked everything on finding a cure for influenza D. people who understand what is at stake when it comes to influenza pandemics 5. funding is limited in line 6 of paragraph 3 means: A. not much is known B. work has barely begun C. not much money is available D. there is not much interest 1
6. vaccines are grossly underused in lines 6-7 of paragraph 3 means: A. mass vaccination has already been carried out B. it is shocking how few people know how to use vaccines properly C. vaccination is a crude and relatively ineffective measure D. vaccines are employed a lot less than they should be 7. Moreover in the penultimate line of paragraph 3 could be replaced by A. Similarly B. Yet C. However D. Furthermore 8. The fourth paragraph tells us that: A. all those taking part in a WHO consultation in May 2002 agreed with the agenda B. only four of a total of 17 priorities are going to be addressed C. Gro Harlem Brundtland criticizes the decision of the WHO to focus only on its existing strengths D. the global agenda does not provide unbiased orientation on influenza control 9. If you wish to consult the full text of the Global Agenda on Influenza you should: A. order a copy on the Internet B. buy the book referenced in the footnote C. visit the website given at the end of the text D. be a registered physician and first obtain permission from the Director General 10. This text was probably written: A. to respond to the recent H1N1 outbreak B. shortly after the WHO consultation mentioned in the text C. to address the concerns of the general public regarding a major influenza pandemic D. towards the end of the 20 th century 2
TEXT 1 Influenza WHO cares This summer, the WHO put together an historic document: the first Global agenda on Influenza Surveillance, Prevention and Control.[1] Why is this so important? This is the first time that a strategic roadmap has been developed containing long-term priorities to reduce morbidity and mortality from annual influenza epidemics and to prepare for the next influenza pandemic. During the influenza epidemics every year, an estimated half a million people worldwide die. The four pandemics in the last century alone claimed more than 50 million lives. In 2001, only 250 million vaccine doses were used globally, whereas the people at greatest risk of dying from influenza those aged over 65 already number more than 380 million. The vast majority of people, particularly, but not exclusively, those in developing countries, have no access to the vaccine or are unaware of the benefits of vaccination. The Global Agenda on Influenza could become a milestone in influenza control. Although the WHO Global Influenza Programme initiated the work on the Global Agenda, it was developed through a consultative and transparent process involving stakeholders from ministries of health, academia, non-governmental organisations, and the pharmaceutical industry. Collaboration, vision, and leadership are critical in influenza control where funding is limited for research and development, vaccines are grossly underused, and attention is almost exclusively focusing on developed countries. This focus is surprising given the clear evidence of the clinical importance of influenza in developing countries. Moreover, an influenza pandemic will have its greatest impact on developing countries where there is no vaccine and antiviral production. The Global Agenda, which was endorsed by the more than 60 participants during a consultation at WHO on May 6 7, 2002, contains 17 priority actions focusing on four major themes: (1) strengthen disease and virological surveillance nationally and internationally; (2) increase knowledge on the health and economic burden of influenza; (3) increase influenza vaccine usage; and (4) accelerate national and international action on pandemic preparedness. In opening the consultation, Gro Harlem Brundtland, Director General of WHO, stressed the importance to WHO of the Global Agenda for focusing on what we do best. As important, the Global Agenda shows the way for all those who need impartial guidance on priorities for research and development and national/global action for influenza control. It will also help to support fund raising for influenza control at national and international levels. The WHO Global Influenza Programme intends to maintain the current momentum of international strategy development and will continue to provide leadership in influenza prevention and control. The Global Agenda and further information can be found at: http://who.int/influenza. References 1 WHO Global Influenza Programme.http://www.who.int/emc/diseases/flu/global_agenda_report/Introduction.htm (accessed Aug 6, 2002). THE LANCET Infectious Diseases Vol 2 September 2002 http://infection.thelancet.com 3
PART 2 Answer Questions 11-20 with reference to TEXT 2 that follows. Only one option is correct for each question. 11. Which of the following statements is true? A. The word issues in the title could be replaced by editions B. The word safety in the title could be replaced by security C. The word supply in the title could be replaced by provision D. The word surrounding in the title could be replaced by embracing 12. The phrase several thorny issues in the first paragraph could be replaced by: A. serious hard challenges B. many crafty questions C. a few difficult matters D. a number of challenging problems 13. Which of the following pieces of information is TRUE according to the second paragraph? A. Clever people also believe that people should take an extra two doses of the vaccine on top of the one already recommended. B. Every country will need the vaccine, although, at present it is not possible to produce it in sufficient quantities worldwide to satisfy this demand. C. Health professionals warn that taking two doses of the vaccine will reduce its potency. D. Some companies are trying to find a way of developing the vaccine using crop seed. 14. It can be understood from the third paragraph that adjuvants are: A. substances added to the vaccine to enhance its effectiveness B. members of the public who volunteer to help distribute the vaccine C. likely to be viewed as necessary and effective by the United States FDA D. reduced dosages of vaccine that may prove to be dangerous and ineffective 15. Might in the third line of paragraph 4 could be replaced by: A. must B. should C. could D. ought to be 4
16. Therefore in paragraph 4 line 4 could be replaced by: A. likewise B. nevertheless C. thus D. so 17. The word some in paragraph 4 line 5 refers to: A. complications B. apprehensions regarding the vaccination campaign C. post-marketing surveillance D. an unspecified number of people 18. In 1976: A. vaccination was ineffective because it was not carried out on a large enough scale B. there were fears of a repeat of the H1N1 pandemic C. the campaign was discontinued as the vaccine had to be removed from circulation D. the vaccine had to be withdrawn from those who had received it 19. The overall context of the article leads one to understand that rolling out in the last paragraph means: A. presenting a product to the public for the first time B. introducing a product in a series of stages, each involving increasingly broader coverage C. withdrawing a product in a series of stages, each involving increasingly narrower coverage D. removing a product from its casing by flattening it 20. This text was probably written: A. by the FDA, to counter misconceptions regarding the efficacy of the influenza vaccine B. to address recent developments in the worldwide response to the H1N1 outbreak C. to quell widespread panic among the general public with regard to a major influenza pandemic D. last week 5
TEXT 2 Supply and safety issues surrounding an H1N1 vaccine Last week, Australia and the USA announced that they would begin trials of an H1N1 vaccine. Vaccination against H1N1 will be an important development in controlling the impact of the pandemic. However, several thorny issues exist around vaccine manufacture and approval. All countries will require the vaccine but current global manufacturing capacity will not be able to meet this demand. Additionally, experts think that individuals might need two doses of the vaccine instead of one, reducing capacity further. Vaccine manufacturers are also struggling to produce good vaccine yields with the H1N1 seed virus. One way to ease these supply problems is the use of adjuvants in a vaccine. On July 7, WHO s Strategic Advisory Group of Experts on Immunization recommended that vaccine formulated with oil-in-water adjuvants and live-attenuated influenza vaccines should be promoted to help increase the global supply of a vaccine and because they are better at protecting against strain variations. Yet there are signs that the USA might not follow this recommendation. Adjuvant use would be contingent upon showing that it was needed or clearly beneficial, Jesse Goodman, acting chief scientist and deputy commissioner of the Food and Drug Administration told a press briefing on July 17. The USA must support the use of dose-sparing strategies to avoid depletion of an already short vaccine supply. As well as availability, safety of an H1N1 vaccine is a concern. Many national regulatory agencies have set up fast-track approval processes for the H1N1 vaccine, which means that a vaccine might be licensed without the usual safety and efficacy data requirements. Vaccine safety will therefore have to be monitored through postmarketing surveillance. But some fear a repeat of the 1976 H1N1 outbreak in the USA, where mass vaccination was associated with complications, which stopped the campaign and led to the withdrawal of the vaccine. Countries need to assess carefully the risks and benefits of rapid approval of an H1N1 vaccine, especially since the disease has so far been mild with most patients making a full recovery. They must also ensure that they have strong post-marketing surveillance in place before rolling out a vaccine. The Lancet 6
Centro de Pesquisas AGGEU MAGALHÃES Prova de ingles Quinta feira dia 29 de outubro de 2009 09h00 12h00 MESTRADO ACADÊMICO EM SAÚDE PÚBLICA 2010 ( ) MESTRADO PROFISSIONAL 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 7
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