國立中興大學 112 年 《英文》

British physician Thomas Percival, echoing the words of Francis Bacon, insisted that it was the physician’s responsibility to “____ despair, alleviate pain, and soothe mental anguish.”

The term “international medical graduates” (IMGs) is generally understood to ____ a physician who is awarded their medical degree in a country other than the one where they intend to practice medicine.

Art as therapy is considered product-oriented because it’s satisfying to create a piece of art that is ____ pleasing.

Rural practice is different from urban practice and different from the practices that most physicians might have learned while in ____ training.

Doctors are frequently criticized for their lack of “humanity”: interest in the symptom rather than the person, a ____ manner and cultivated professional indifference to “difference.”

Good therapeutic relationships were described as having the quality of humility, and remote participants appreciated doctors who were not ____ when patients wished not to be referred to certain specialists perceived to scold them.

In some countries, routine episiotomies and the use of oxytocin during a normal labor appeared to ____ women from seeking skilled care during pregnancy, childbirth, and the postpartum period.

A NSW community-based ____ and hospice care service were comprehensively assessed for sustainability, and several challenges were identified, such as the need to examine models of end-of-life care for rural patients.

Indigenous people in various industrialized countries tend to have a shorter life ____ and higher mortality rates compared with other ethnic groups.

To properly diagnose sickle cell disease in rural Kenya, physicians at regional hospitals often strive to be ____ when examining patients and performing predictive testing.

【題組共用題幹】

In recent years, researchers in emergency rooms have been testing the effects of artificial blood substitutes such as PolyHeme and Hemopure. The development of such a substitute would ____ a significant achievement with many health benefits. Blood transfusions, ____, would be easier and safer, as there would be no need to match blood types, and the risk of ____ viruses would be avoided as well. There would no longer be a shortage of blood in large cities or in rural areas, as artificial blood substitutes can last for two years, much longer than blood can be stored. But the ____ of this research is questionable because patients who are in need of blood transfusions in the emergency room are often unconscious and therefore do not have the opportunity to ____ to this research.

【題組共用題幹】

In recent years, researchers in emergency rooms have been testing the effects of artificial blood substitutes such as PolyHeme and Hemopure. The development of such a substitute would ____ a significant achievement with many health benefits. Blood transfusions, ____, would be easier and safer, as there would be no need to match blood types, and the risk of ____ viruses would be avoided as well. There would no longer be a shortage of blood in large cities or in rural areas, as artificial blood substitutes can last for two years, much longer than blood can be stored. But the ____ of this research is questionable because patients who are in need of blood transfusions in the emergency room are often unconscious and therefore do not have the opportunity to ____ to this research.

【題組共用題幹】

In recent years, researchers in emergency rooms have been testing the effects of artificial blood substitutes such as PolyHeme and Hemopure. The development of such a substitute would ____ a significant achievement with many health benefits. Blood transfusions, ____, would be easier and safer, as there would be no need to match blood types, and the risk of ____ viruses would be avoided as well. There would no longer be a shortage of blood in large cities or in rural areas, as artificial blood substitutes can last for two years, much longer than blood can be stored. But the ____ of this research is questionable because patients who are in need of blood transfusions in the emergency room are often unconscious and therefore do not have the opportunity to ____ to this research.

【題組共用題幹】

In recent years, researchers in emergency rooms have been testing the effects of artificial blood substitutes such as PolyHeme and Hemopure. The development of such a substitute would ____ a significant achievement with many health benefits. Blood transfusions, ____, would be easier and safer, as there would be no need to match blood types, and the risk of ____ viruses would be avoided as well. There would no longer be a shortage of blood in large cities or in rural areas, as artificial blood substitutes can last for two years, much longer than blood can be stored. But the ____ of this research is questionable because patients who are in need of blood transfusions in the emergency room are often unconscious and therefore do not have the opportunity to ____ to this research.

【題組共用題幹】

In recent years, researchers in emergency rooms have been testing the effects of artificial blood substitutes such as PolyHeme and Hemopure. The development of such a substitute would ____ a significant achievement with many health benefits. Blood transfusions, ____, would be easier and safer, as there would be no need to match blood types, and the risk of ____ viruses would be avoided as well. There would no longer be a shortage of blood in large cities or in rural areas, as artificial blood substitutes can last for two years, much longer than blood can be stored. But the ____ of this research is questionable because patients who are in need of blood transfusions in the emergency room are often unconscious and therefore do not have the opportunity to ____ to this research.

【題組共用題幹】

Mount Isa is a remote mining town in northwestern Queensland. The town has an approximately 17% aboriginal population. There are many programs designed specifically for the aboriginal population and many health services available in the regional center. ____, many health practitioners and aboriginal people have expressed concerns over the health and well-being of the aboriginal population, variously as a perceived lack of ____ or an overburdening of many of these services and programs. Many people ____ these issues to lack of transportation, lack of money and cultural or language barriers.

An ethnographic study conducted in Mount Isa disclosed health care accessibility issues. Many of the issues identified in interviews ____ discussion of culture such as taboo and obligation, etiquette, kinship structures, social networks, values and beliefs. Other issues were not specifically cultural, dealt ____ with structural elements of the health care setting, institution or system itself. Accordingly, issues were categorized as social, cultural and structural to demonstrate the ways that “culture” is inclusive of many categories of phenomena, while also able to be narrowed down to human belief and value systems.

【題組共用題幹】

Mount Isa is a remote mining town in northwestern Queensland. The town has an approximately 17% aboriginal population. There are many programs designed specifically for the aboriginal population and many health services available in the regional center. ____, many health practitioners and aboriginal people have expressed concerns over the health and well-being of the aboriginal population, variously as a perceived lack of ____ or an overburdening of many of these services and programs. Many people ____ these issues to lack of transportation, lack of money and cultural or language barriers.

An ethnographic study conducted in Mount Isa disclosed health care accessibility issues. Many of the issues identified in interviews ____ discussion of culture such as taboo and obligation, etiquette, kinship structures, social networks, values and beliefs. Other issues were not specifically cultural, dealt ____ with structural elements of the health care setting, institution or system itself. Accordingly, issues were categorized as social, cultural and structural to demonstrate the ways that “culture” is inclusive of many categories of phenomena, while also able to be narrowed down to human belief and value systems.

【題組共用題幹】

Mount Isa is a remote mining town in northwestern Queensland. The town has an approximately 17% aboriginal population. There are many programs designed specifically for the aboriginal population and many health services available in the regional center. ____, many health practitioners and aboriginal people have expressed concerns over the health and well-being of the aboriginal population, variously as a perceived lack of ____ or an overburdening of many of these services and programs. Many people ____ these issues to lack of transportation, lack of money and cultural or language barriers.

An ethnographic study conducted in Mount Isa disclosed health care accessibility issues. Many of the issues identified in interviews ____ discussion of culture such as taboo and obligation, etiquette, kinship structures, social networks, values and beliefs. Other issues were not specifically cultural, dealt ____ with structural elements of the health care setting, institution or system itself. Accordingly, issues were categorized as social, cultural and structural to demonstrate the ways that “culture” is inclusive of many categories of phenomena, while also able to be narrowed down to human belief and value systems.

【題組共用題幹】

Mount Isa is a remote mining town in northwestern Queensland. The town has an approximately 17% aboriginal population. There are many programs designed specifically for the aboriginal population and many health services available in the regional center. ____, many health practitioners and aboriginal people have expressed concerns over the health and well-being of the aboriginal population, variously as a perceived lack of ____ or an overburdening of many of these services and programs. Many people ____ these issues to lack of transportation, lack of money and cultural or language barriers.

An ethnographic study conducted in Mount Isa disclosed health care accessibility issues. Many of the issues identified in interviews ____ discussion of culture such as taboo and obligation, etiquette, kinship structures, social networks, values and beliefs. Other issues were not specifically cultural, dealt ____ with structural elements of the health care setting, institution or system itself. Accordingly, issues were categorized as social, cultural and structural to demonstrate the ways that “culture” is inclusive of many categories of phenomena, while also able to be narrowed down to human belief and value systems.

【題組共用題幹】

Mount Isa is a remote mining town in northwestern Queensland. The town has an approximately 17% aboriginal population. There are many programs designed specifically for the aboriginal population and many health services available in the regional center. ____, many health practitioners and aboriginal people have expressed concerns over the health and well-being of the aboriginal population, variously as a perceived lack of ____ or an overburdening of many of these services and programs. Many people ____ these issues to lack of transportation, lack of money and cultural or language barriers.

An ethnographic study conducted in Mount Isa disclosed health care accessibility issues. Many of the issues identified in interviews ____ discussion of culture such as taboo and obligation, etiquette, kinship structures, social networks, values and beliefs. Other issues were not specifically cultural, dealt ____ with structural elements of the health care setting, institution or system itself. Accordingly, issues were categorized as social, cultural and structural to demonstrate the ways that “culture” is inclusive of many categories of phenomena, while also able to be narrowed down to human belief and value systems.

【題組共用題幹】

Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma.

Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors.

Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs,” presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient.

A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began.

Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.

Based on the information in the passage, which of the following is true?

【題組共用題幹】

Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma.

Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors.

Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs,” presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient.

A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began.

Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.

According to the passage which of the following is not true?

【題組共用題幹】

Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma.

Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors.

Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs,” presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient.

A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began.

Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.

Which of the following instances of unsafe health care is not discussed, either directly or indirectly, in the passage?

【題組共用題幹】

Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma.

Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors.

Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs,” presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient.

A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began.

Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.

The word “mitigating” as it is used in the final paragraph most nearly means ____.

【題組共用題幹】

Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma.

Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors.

Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs,” presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient.

A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began.

Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.

What is the most likely reason that in the final paragraph the “ongoing colonial dynamics” is mentioned?

【題組共用題幹】

George Gordon Byron was born in London on 22 January 1788 with a deformed foot, the nature of which has been disputed. His father, who died when Byron was three years old, labelled his son “club-footed,” and evidence from several sources strongly supports that assessment. His mother’s description of him aged four, which indicated that his foot “turns inward […] and he walks quite on the side of his foot,” is consistent with the diagnosis of congenital talipes equinovarus, or clubfoot. In fact, talipes in Latin means “to walk on the ____.”

Talipes equinovarus, a congenital abnormality recognized since antiquity, occurs in approximately 1 in 1000 of live births, affects males about twice as frequently as females, and involves both feet in about one half of cases. When unilateral, it is more common on the right than the left.

When George Gordon Byron was aged ten, he became Lord Byron, inheriting the title of the sixth Baron Byron of Rochdale after his great-uncle died. He and his mother moved to Nottingham, near the decaying and debt-ridden estate of Newstead Abbey which he also inherited. There she employed a man known from our sources only by his surname, Lavender, who claimed an ability to cure her son’s deformity. Listed in the Nottingham directory as a surgeon, he was actually a maker of medical appliances for the general hospital. His excruciating regimen was to rub Byron’s foot with oil, twist it, and screw it up in a wooden contraption. His tutor remarked one day how uncomfortable he felt observing his student in such pain. “Never mind, Mr. Rogers,” Byron replied, “you shall not see any signs of it in me.”

When Byron was taken to London in 1799, Dr Matthew Baillie (1761–1823) thought that early treatment might have greatly or wholly corrected the deformity, but by this time it was too late. Nevertheless, he had the bonesetter Timothy Sheldrake make some instruments for Byron’s foot. These were shortly abandoned, however, and he received a boot instead. Later that year, Sheldrake constructed a device that Baillie had designed to straighten the foot. Byron wrote: “My foot goes but indifferently. I cannot see any alteration.”

Sheldrake reported that he made plaster casts of the deformity and, in his 1828 account in the medical journal Lancet, appended drawings of them. They indeed indicate a clubfoot, but on the left, not the right, suggesting that the figures were inaccurate, from another patient, or, in fact, genuine representations of Byron’s foot, reversed because of the engraving process, which creates mirror images of the original drawings. Shortly before Byron’s death in 1824 in Greece, Dr Julius Millingen (1800–78), although also misidentifying which side was affected, commented: “The foot was deformed and turned inwards; and the leg was smaller and shorter than the sound one […] [T]here can be little or no doubt, that he was born club-footed.”

Based on Byron’s mother’s description of his deformed foot in paragraph 1, talipes in Latin is most likely to mean “to walk on the ____” in English. What is the most appropriate answer to the blank?

【題組共用題幹】

George Gordon Byron was born in London on 22 January 1788 with a deformed foot, the nature of which has been disputed. His father, who died when Byron was three years old, labelled his son “club-footed,” and evidence from several sources strongly supports that assessment. His mother’s description of him aged four, which indicated that his foot “turns inward […] and he walks quite on the side of his foot,” is consistent with the diagnosis of congenital talipes equinovarus, or clubfoot. In fact, talipes in Latin means “to walk on the ____.”

Talipes equinovarus, a congenital abnormality recognized since antiquity, occurs in approximately 1 in 1000 of live births, affects males about twice as frequently as females, and involves both feet in about one half of cases. When unilateral, it is more common on the right than the left.

When George Gordon Byron was aged ten, he became Lord Byron, inheriting the title of the sixth Baron Byron of Rochdale after his great-uncle died. He and his mother moved to Nottingham, near the decaying and debt-ridden estate of Newstead Abbey which he also inherited. There she employed a man known from our sources only by his surname, Lavender, who claimed an ability to cure her son’s deformity. Listed in the Nottingham directory as a surgeon, he was actually a maker of medical appliances for the general hospital. His excruciating regimen was to rub Byron’s foot with oil, twist it, and screw it up in a wooden contraption. His tutor remarked one day how uncomfortable he felt observing his student in such pain. “Never mind, Mr. Rogers,” Byron replied, “you shall not see any signs of it in me.”

When Byron was taken to London in 1799, Dr Matthew Baillie (1761–1823) thought that early treatment might have greatly or wholly corrected the deformity, but by this time it was too late. Nevertheless, he had the bonesetter Timothy Sheldrake make some instruments for Byron’s foot. These were shortly abandoned, however, and he received a boot instead. Later that year, Sheldrake constructed a device that Baillie had designed to straighten the foot. Byron wrote: “My foot goes but indifferently. I cannot see any alteration.”

Sheldrake reported that he made plaster casts of the deformity and, in his 1828 account in the medical journal Lancet, appended drawings of them. They indeed indicate a clubfoot, but on the left, not the right, suggesting that the figures were inaccurate, from another patient, or, in fact, genuine representations of Byron’s foot, reversed because of the engraving process, which creates mirror images of the original drawings. Shortly before Byron’s death in 1824 in Greece, Dr Julius Millingen (1800–78), although also misidentifying which side was affected, commented: “The foot was deformed and turned inwards; and the leg was smaller and shorter than the sound one […] [T]here can be little or no doubt, that he was born club-footed.”

According to this passage, which of the following is NOT a fact about talipes equinovarus, or clubfoot?

【題組共用題幹】

George Gordon Byron was born in London on 22 January 1788 with a deformed foot, the nature of which has been disputed. His father, who died when Byron was three years old, labelled his son “club-footed,” and evidence from several sources strongly supports that assessment. His mother’s description of him aged four, which indicated that his foot “turns inward […] and he walks quite on the side of his foot,” is consistent with the diagnosis of congenital talipes equinovarus, or clubfoot. In fact, talipes in Latin means “to walk on the ____.”

Talipes equinovarus, a congenital abnormality recognized since antiquity, occurs in approximately 1 in 1000 of live births, affects males about twice as frequently as females, and involves both feet in about one half of cases. When unilateral, it is more common on the right than the left.

When George Gordon Byron was aged ten, he became Lord Byron, inheriting the title of the sixth Baron Byron of Rochdale after his great-uncle died. He and his mother moved to Nottingham, near the decaying and debt-ridden estate of Newstead Abbey which he also inherited. There she employed a man known from our sources only by his surname, Lavender, who claimed an ability to cure her son’s deformity. Listed in the Nottingham directory as a surgeon, he was actually a maker of medical appliances for the general hospital. His excruciating regimen was to rub Byron’s foot with oil, twist it, and screw it up in a wooden contraption. His tutor remarked one day how uncomfortable he felt observing his student in such pain. “Never mind, Mr. Rogers,” Byron replied, “you shall not see any signs of it in me.”

When Byron was taken to London in 1799, Dr Matthew Baillie (1761–1823) thought that early treatment might have greatly or wholly corrected the deformity, but by this time it was too late. Nevertheless, he had the bonesetter Timothy Sheldrake make some instruments for Byron’s foot. These were shortly abandoned, however, and he received a boot instead. Later that year, Sheldrake constructed a device that Baillie had designed to straighten the foot. Byron wrote: “My foot goes but indifferently. I cannot see any alteration.”

Sheldrake reported that he made plaster casts of the deformity and, in his 1828 account in the medical journal Lancet, appended drawings of them. They indeed indicate a clubfoot, but on the left, not the right, suggesting that the figures were inaccurate, from another patient, or, in fact, genuine representations of Byron’s foot, reversed because of the engraving process, which creates mirror images of the original drawings. Shortly before Byron’s death in 1824 in Greece, Dr Julius Millingen (1800–78), although also misidentifying which side was affected, commented: “The foot was deformed and turned inwards; and the leg was smaller and shorter than the sound one […] [T]here can be little or no doubt, that he was born club-footed.”

Where does the following sentence best belong?

According to his later friend, John Cam Hobhouse (1786–1869), “he wore the instrument with impatience and threw it in the pond.”

【題組共用題幹】

George Gordon Byron was born in London on 22 January 1788 with a deformed foot, the nature of which has been disputed. His father, who died when Byron was three years old, labelled his son “club-footed,” and evidence from several sources strongly supports that assessment. His mother’s description of him aged four, which indicated that his foot “turns inward […] and he walks quite on the side of his foot,” is consistent with the diagnosis of congenital talipes equinovarus, or clubfoot. In fact, talipes in Latin means “to walk on the ____.”

Talipes equinovarus, a congenital abnormality recognized since antiquity, occurs in approximately 1 in 1000 of live births, affects males about twice as frequently as females, and involves both feet in about one half of cases. When unilateral, it is more common on the right than the left.

When George Gordon Byron was aged ten, he became Lord Byron, inheriting the title of the sixth Baron Byron of Rochdale after his great-uncle died. He and his mother moved to Nottingham, near the decaying and debt-ridden estate of Newstead Abbey which he also inherited. There she employed a man known from our sources only by his surname, Lavender, who claimed an ability to cure her son’s deformity. Listed in the Nottingham directory as a surgeon, he was actually a maker of medical appliances for the general hospital. His excruciating regimen was to rub Byron’s foot with oil, twist it, and screw it up in a wooden contraption. His tutor remarked one day how uncomfortable he felt observing his student in such pain. “Never mind, Mr. Rogers,” Byron replied, “you shall not see any signs of it in me.”

When Byron was taken to London in 1799, Dr Matthew Baillie (1761–1823) thought that early treatment might have greatly or wholly corrected the deformity, but by this time it was too late. Nevertheless, he had the bonesetter Timothy Sheldrake make some instruments for Byron’s foot. These were shortly abandoned, however, and he received a boot instead. Later that year, Sheldrake constructed a device that Baillie had designed to straighten the foot. Byron wrote: “My foot goes but indifferently. I cannot see any alteration.”

Sheldrake reported that he made plaster casts of the deformity and, in his 1828 account in the medical journal Lancet, appended drawings of them. They indeed indicate a clubfoot, but on the left, not the right, suggesting that the figures were inaccurate, from another patient, or, in fact, genuine representations of Byron’s foot, reversed because of the engraving process, which creates mirror images of the original drawings. Shortly before Byron’s death in 1824 in Greece, Dr Julius Millingen (1800–78), although also misidentifying which side was affected, commented: “The foot was deformed and turned inwards; and the leg was smaller and shorter than the sound one […] [T]here can be little or no doubt, that he was born club-footed.”

The word “excruciating” in paragraph 3 is closest in meaning to ____.

【題組共用題幹】

George Gordon Byron was born in London on 22 January 1788 with a deformed foot, the nature of which has been disputed. His father, who died when Byron was three years old, labelled his son “club-footed,” and evidence from several sources strongly supports that assessment. His mother’s description of him aged four, which indicated that his foot “turns inward […] and he walks quite on the side of his foot,” is consistent with the diagnosis of congenital talipes equinovarus, or clubfoot. In fact, talipes in Latin means “to walk on the ____.”

Talipes equinovarus, a congenital abnormality recognized since antiquity, occurs in approximately 1 in 1000 of live births, affects males about twice as frequently as females, and involves both feet in about one half of cases. When unilateral, it is more common on the right than the left.

When George Gordon Byron was aged ten, he became Lord Byron, inheriting the title of the sixth Baron Byron of Rochdale after his great-uncle died. He and his mother moved to Nottingham, near the decaying and debt-ridden estate of Newstead Abbey which he also inherited. There she employed a man known from our sources only by his surname, Lavender, who claimed an ability to cure her son’s deformity. Listed in the Nottingham directory as a surgeon, he was actually a maker of medical appliances for the general hospital. His excruciating regimen was to rub Byron’s foot with oil, twist it, and screw it up in a wooden contraption. His tutor remarked one day how uncomfortable he felt observing his student in such pain. “Never mind, Mr. Rogers,” Byron replied, “you shall not see any signs of it in me.”

When Byron was taken to London in 1799, Dr Matthew Baillie (1761–1823) thought that early treatment might have greatly or wholly corrected the deformity, but by this time it was too late. Nevertheless, he had the bonesetter Timothy Sheldrake make some instruments for Byron’s foot. These were shortly abandoned, however, and he received a boot instead. Later that year, Sheldrake constructed a device that Baillie had designed to straighten the foot. Byron wrote: “My foot goes but indifferently. I cannot see any alteration.”

Sheldrake reported that he made plaster casts of the deformity and, in his 1828 account in the medical journal Lancet, appended drawings of them. They indeed indicate a clubfoot, but on the left, not the right, suggesting that the figures were inaccurate, from another patient, or, in fact, genuine representations of Byron’s foot, reversed because of the engraving process, which creates mirror images of the original drawings. Shortly before Byron’s death in 1824 in Greece, Dr Julius Millingen (1800–78), although also misidentifying which side was affected, commented: “The foot was deformed and turned inwards; and the leg was smaller and shorter than the sound one […] [T]here can be little or no doubt, that he was born club-footed.”

Based on the information in this passage, which of the following is the most correct statement about Byron?

【題組共用題幹】

Much of the research of the past few decades has examined which therapies to use and how to use them. Which medication, what does, for how long? Which procedure? What’s the benefit? These are all questions commonly asked and that can now be regularly and reliably answered.

Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, based on a rapidly growing cornerstone of evidence, have saved lives. These forms of evidence-based medicine allow patients to benefit from the thoughtful application of what’s been shown to be the most effective therapy.

But effective therapy depends on accurate diagnosis. We now have at our disposal a wide range of tools—new and old—with which we might now make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision making will take place at the level of the diagnosis.

The patient’s story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms and hunch. An elderly man with a fever and a cough has an X-ray revealing a raging pneumonia. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG (____) or blood test bears out the suspicion that he is having a heart attack. A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT (Computed Tomography) scan proves the presence of a massive pulmonary embolus. This is the bread and butter of medical diagnosis—cases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why.

But then there are the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading. Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don his/her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

What can be inferred from the first three paragraphs?

【題組共用題幹】

Much of the research of the past few decades has examined which therapies to use and how to use them. Which medication, what does, for how long? Which procedure? What’s the benefit? These are all questions commonly asked and that can now be regularly and reliably answered.

Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, based on a rapidly growing cornerstone of evidence, have saved lives. These forms of evidence-based medicine allow patients to benefit from the thoughtful application of what’s been shown to be the most effective therapy.

But effective therapy depends on accurate diagnosis. We now have at our disposal a wide range of tools—new and old—with which we might now make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision making will take place at the level of the diagnosis.

The patient’s story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms and hunch. An elderly man with a fever and a cough has an X-ray revealing a raging pneumonia. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG (____) or blood test bears out the suspicion that he is having a heart attack. A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT (Computed Tomography) scan proves the presence of a massive pulmonary embolus. This is the bread and butter of medical diagnosis—cases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why.

But then there are the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading. Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don his/her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

Where does the following sentence best belong?

Often the diagnosis is straightforward.

【題組共用題幹】

Much of the research of the past few decades has examined which therapies to use and how to use them. Which medication, what does, for how long? Which procedure? What’s the benefit? These are all questions commonly asked and that can now be regularly and reliably answered.

Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, based on a rapidly growing cornerstone of evidence, have saved lives. These forms of evidence-based medicine allow patients to benefit from the thoughtful application of what’s been shown to be the most effective therapy.

But effective therapy depends on accurate diagnosis. We now have at our disposal a wide range of tools—new and old—with which we might now make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision making will take place at the level of the diagnosis.

The patient’s story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms and hunch. An elderly man with a fever and a cough has an X-ray revealing a raging pneumonia. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG (____) or blood test bears out the suspicion that he is having a heart attack. A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT (Computed Tomography) scan proves the presence of a massive pulmonary embolus. This is the bread and butter of medical diagnosis—cases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why.

But then there are the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading. Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don his/her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

What is the most appropriate answer to the blank in paragraph 4? In other words, what does “EKG” stand for?

【題組共用題幹】

Much of the research of the past few decades has examined which therapies to use and how to use them. Which medication, what does, for how long? Which procedure? What’s the benefit? These are all questions commonly asked and that can now be regularly and reliably answered.

Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, based on a rapidly growing cornerstone of evidence, have saved lives. These forms of evidence-based medicine allow patients to benefit from the thoughtful application of what’s been shown to be the most effective therapy.

But effective therapy depends on accurate diagnosis. We now have at our disposal a wide range of tools—new and old—with which we might now make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision making will take place at the level of the diagnosis.

The patient’s story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms and hunch. An elderly man with a fever and a cough has an X-ray revealing a raging pneumonia. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG (____) or blood test bears out the suspicion that he is having a heart attack. A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT (Computed Tomography) scan proves the presence of a massive pulmonary embolus. This is the bread and butter of medical diagnosis—cases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why.

But then there are the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading. Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don his/her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

Based on the information in the last two paragraphs, which of the following is true?

【題組共用題幹】

Much of the research of the past few decades has examined which therapies to use and how to use them. Which medication, what does, for how long? Which procedure? What’s the benefit? These are all questions commonly asked and that can now be regularly and reliably answered.

Treatment guidelines for many diseases are published, available, and regularly used. And despite concerns and lamentations about “cookbook medicine,” these guidelines, based on a rapidly growing cornerstone of evidence, have saved lives. These forms of evidence-based medicine allow patients to benefit from the thoughtful application of what’s been shown to be the most effective therapy.

But effective therapy depends on accurate diagnosis. We now have at our disposal a wide range of tools—new and old—with which we might now make a timely and accurate diagnosis. And as treatment becomes more standardized, the most complex and important decision making will take place at the level of the diagnosis.

The patient’s story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms and hunch. An elderly man with a fever and a cough has an X-ray revealing a raging pneumonia. A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG (____) or blood test bears out the suspicion that he is having a heart attack. A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT (Computed Tomography) scan proves the presence of a massive pulmonary embolus. This is the bread and butter of medical diagnosis—cases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why.

But then there are the other cases: patients with complicated stories or medical histories; cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading. Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don his/her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

The phrase “bread and butter” in paragraph 4 is closest in meaning to ____.

【題組共用題幹】

Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.

The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.

Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their whānau. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.

Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies.

Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their whānau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensure the efficacy for whānau Māori.

Which of the following best describes what the passage is about?

【題組共用題幹】

Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.

The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.

Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their whānau. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.

Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies.

Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their whānau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensure the efficacy for whānau Māori.

Which of the following could best replace the word “whānau” as used in paragraphs 3 and 5?

【題組共用題幹】

Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.

The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.

Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their whānau. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.

Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies.

Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their whānau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensure the efficacy for whānau Māori.

The word “refinement” as it is used in paragraph 5 most nearly means ____.

【題組共用題幹】

Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.

The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.

Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their whānau. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.

Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies.

Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their whānau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensure the efficacy for whānau Māori.

Based on the information in the passage, which of the following is NOT true?

【題組共用題幹】

Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.

The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.

Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their whānau. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.

Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies.

Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their whānau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensure the efficacy for whānau Māori.

Based on the information in the passage, which of the following is true?

【題組共用題幹】

In spring 2008, the possible subject matter for picture books expanded into a new realm with the publication of My Beautiful Mommy. Written by Michael Salzhauer and illustrated by Victor Guiza, the narrative is billed as the first picture book to address the subject of cosmetic surgery.

Told from a first-person perspective, My Beautiful Mommy relays the experiences of a young girl whose mother is about to undergo multiple elective aesthetic procedures. Although the story is fictional, it takes an informational rather than imaginative approach: the narrative provides young readers with a type of “guided tour” or instructive overview of the process.

My Beautiful Mommy begins with the mother’s initial consultation at the doctor’s office, progresses to the day of her surgery, discusses the period of her ____, and ends with the removal of her bandages and the unveiling of her new, cosmetically altered self. To help explain the entire cosmetic surgery experience to child readers, the book appropriates a common metaphor from nature: it compares the mother’s transformation to that of a caterpillar into a butterfly, complete with even likening her bandages to a cocoon.

The mother in My Beautiful Mommy is undergoing not simply a random cluster of cosmetic surgery procedures, but a specific grouping known as the “mommy makeover.” Comprised of a tummy ____, liposuction, and a breast lift (with or without implants), it is a designed to help mothers regain their pre-pregnancy form. Given the growing number of women undergoing cosmetic surgery, coupled with the growing societal belief that parents ought to be more honest and open with their children, there was a growing need to have such procedures explained in a manner that young people could understand.

As Abigail Jones aptly observed, while much attention has been paid to “the emotional effects plastic surgery can have on patients,” few have addressed the question “how does a mother’s plastic surgery affect her kids?”. My Beautiful Mommy seeks to do just that. Released on the symbolic date of Mother’s Day in 2008, the picture book is aimed at children ages four through seven, and it is intended to ease the fear and anxiety that children experience when a parent undergoes cosmetic surgery.

What can be inferred from the first three paragraphs?

【題組共用題幹】

In spring 2008, the possible subject matter for picture books expanded into a new realm with the publication of My Beautiful Mommy. Written by Michael Salzhauer and illustrated by Victor Guiza, the narrative is billed as the first picture book to address the subject of cosmetic surgery.

Told from a first-person perspective, My Beautiful Mommy relays the experiences of a young girl whose mother is about to undergo multiple elective aesthetic procedures. Although the story is fictional, it takes an informational rather than imaginative approach: the narrative provides young readers with a type of “guided tour” or instructive overview of the process.

My Beautiful Mommy begins with the mother’s initial consultation at the doctor’s office, progresses to the day of her surgery, discusses the period of her ____, and ends with the removal of her bandages and the unveiling of her new, cosmetically altered self. To help explain the entire cosmetic surgery experience to child readers, the book appropriates a common metaphor from nature: it compares the mother’s transformation to that of a caterpillar into a butterfly, complete with even likening her bandages to a cocoon.

The mother in My Beautiful Mommy is undergoing not simply a random cluster of cosmetic surgery procedures, but a specific grouping known as the “mommy makeover.” Comprised of a tummy ____, liposuction, and a breast lift (with or without implants), it is a designed to help mothers regain their pre-pregnancy form. Given the growing number of women undergoing cosmetic surgery, coupled with the growing societal belief that parents ought to be more honest and open with their children, there was a growing need to have such procedures explained in a manner that young people could understand.

As Abigail Jones aptly observed, while much attention has been paid to “the emotional effects plastic surgery can have on patients,” few have addressed the question “how does a mother’s plastic surgery affect her kids?”. My Beautiful Mommy seeks to do just that. Released on the symbolic date of Mother’s Day in 2008, the picture book is aimed at children ages four through seven, and it is intended to ease the fear and anxiety that children experience when a parent undergoes cosmetic surgery.

What is the most appropriate answer to the blank in paragraph 4?

【題組共用題幹】

In spring 2008, the possible subject matter for picture books expanded into a new realm with the publication of My Beautiful Mommy. Written by Michael Salzhauer and illustrated by Victor Guiza, the narrative is billed as the first picture book to address the subject of cosmetic surgery.

Told from a first-person perspective, My Beautiful Mommy relays the experiences of a young girl whose mother is about to undergo multiple elective aesthetic procedures. Although the story is fictional, it takes an informational rather than imaginative approach: the narrative provides young readers with a type of “guided tour” or instructive overview of the process.

My Beautiful Mommy begins with the mother’s initial consultation at the doctor’s office, progresses to the day of her surgery, discusses the period of her ____, and ends with the removal of her bandages and the unveiling of her new, cosmetically altered self. To help explain the entire cosmetic surgery experience to child readers, the book appropriates a common metaphor from nature: it compares the mother’s transformation to that of a caterpillar into a butterfly, complete with even likening her bandages to a cocoon.

The mother in My Beautiful Mommy is undergoing not simply a random cluster of cosmetic surgery procedures, but a specific grouping known as the “mommy makeover.” Comprised of a tummy ____, liposuction, and a breast lift (with or without implants), it is a designed to help mothers regain their pre-pregnancy form. Given the growing number of women undergoing cosmetic surgery, coupled with the growing societal belief that parents ought to be more honest and open with their children, there was a growing need to have such procedures explained in a manner that young people could understand.

As Abigail Jones aptly observed, while much attention has been paid to “the emotional effects plastic surgery can have on patients,” few have addressed the question “how does a mother’s plastic surgery affect her kids?”. My Beautiful Mommy seeks to do just that. Released on the symbolic date of Mother’s Day in 2008, the picture book is aimed at children ages four through seven, and it is intended to ease the fear and anxiety that children experience when a parent undergoes cosmetic surgery.

Based on the information in this passage, which of the following statements about My Beautiful Mommy is NOT true?

【題組共用題幹】

In spring 2008, the possible subject matter for picture books expanded into a new realm with the publication of My Beautiful Mommy. Written by Michael Salzhauer and illustrated by Victor Guiza, the narrative is billed as the first picture book to address the subject of cosmetic surgery.

Told from a first-person perspective, My Beautiful Mommy relays the experiences of a young girl whose mother is about to undergo multiple elective aesthetic procedures. Although the story is fictional, it takes an informational rather than imaginative approach: the narrative provides young readers with a type of “guided tour” or instructive overview of the process.

My Beautiful Mommy begins with the mother’s initial consultation at the doctor’s office, progresses to the day of her surgery, discusses the period of her ____, and ends with the removal of her bandages and the unveiling of her new, cosmetically altered self. To help explain the entire cosmetic surgery experience to child readers, the book appropriates a common metaphor from nature: it compares the mother’s transformation to that of a caterpillar into a butterfly, complete with even likening her bandages to a cocoon.

The mother in My Beautiful Mommy is undergoing not simply a random cluster of cosmetic surgery procedures, but a specific grouping known as the “mommy makeover.” Comprised of a tummy ____, liposuction, and a breast lift (with or without implants), it is a designed to help mothers regain their pre-pregnancy form. Given the growing number of women undergoing cosmetic surgery, coupled with the growing societal belief that parents ought to be more honest and open with their children, there was a growing need to have such procedures explained in a manner that young people could understand.

As Abigail Jones aptly observed, while much attention has been paid to “the emotional effects plastic surgery can have on patients,” few have addressed the question “how does a mother’s plastic surgery affect her kids?”. My Beautiful Mommy seeks to do just that. Released on the symbolic date of Mother’s Day in 2008, the picture book is aimed at children ages four through seven, and it is intended to ease the fear and anxiety that children experience when a parent undergoes cosmetic surgery.

Which of the following statements comes closest to this passage’s argument?

【題組共用題幹】

In spring 2008, the possible subject matter for picture books expanded into a new realm with the publication of My Beautiful Mommy. Written by Michael Salzhauer and illustrated by Victor Guiza, the narrative is billed as the first picture book to address the subject of cosmetic surgery.

Told from a first-person perspective, My Beautiful Mommy relays the experiences of a young girl whose mother is about to undergo multiple elective aesthetic procedures. Although the story is fictional, it takes an informational rather than imaginative approach: the narrative provides young readers with a type of “guided tour” or instructive overview of the process.

My Beautiful Mommy begins with the mother’s initial consultation at the doctor’s office, progresses to the day of her surgery, discusses the period of her ____, and ends with the removal of her bandages and the unveiling of her new, cosmetically altered self. To help explain the entire cosmetic surgery experience to child readers, the book appropriates a common metaphor from nature: it compares the mother’s transformation to that of a caterpillar into a butterfly, complete with even likening her bandages to a cocoon.

The mother in My Beautiful Mommy is undergoing not simply a random cluster of cosmetic surgery procedures, but a specific grouping known as the “mommy makeover.” Comprised of a tummy ____, liposuction, and a breast lift (with or without implants), it is a designed to help mothers regain their pre-pregnancy form. Given the growing number of women undergoing cosmetic surgery, coupled with the growing societal belief that parents ought to be more honest and open with their children, there was a growing need to have such procedures explained in a manner that young people could understand.

As Abigail Jones aptly observed, while much attention has been paid to “the emotional effects plastic surgery can have on patients,” few have addressed the question “how does a mother’s plastic surgery affect her kids?”. My Beautiful Mommy seeks to do just that. Released on the symbolic date of Mother’s Day in 2008, the picture book is aimed at children ages four through seven, and it is intended to ease the fear and anxiety that children experience when a parent undergoes cosmetic surgery.

The word “billed” in paragraph 1 is closest in meaning to ____.

【題組共用題幹】

Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care settings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

What is the main purpose of the first paragraph?

【題組共用題幹】

Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care settings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

Which of the following could best replace the word “remainder” as used in paragraph 3?

【題組共用題幹】

Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care settings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

The word “attenuating” as it is used in paragraph 4 most nearly means ____.

【題組共用題幹】

Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care settings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

According to the passage, which of the following is NOT true?

【題組共用題幹】

Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care settings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

Which of the following would be the most appropriate title for this passage?