MD1010 - Ecology of Health 1

JCU MBBS MD1010 EH1 2026

syndrome of clinically identifiable symptoms and signs from an underlying pathological process

disease definition

refers to a patients subjective experience of symptoms and suffering

illness definition

something you must do

obligation

something you ought to do

duty

autonomy, beneficence, non-maleficence, justice

four principle approach to medical ethics

the belief that the doctor knows best and can make decisions on behalf of the patient without involving them

paternalism definition

a persons voluntary decision about medical care which is made with knowledge and understanding of the benefits and risks involved

informed consent definition

threshold element, information element, consent element

three elements of informed consent

the professional provides specialised skills and guarantees commitment professional attributes in return for autonomy in practice and the privilege of self regulation

social contract

the concept of choosing the action which leads to the best consequences

consequentialism definition

the concept of choosing the action that creates the maximal overall welfare or utility

utilitarianism definition

a patients family, employment, housing, financial security, education, leisure, and social support

proximal context

a patients community, economics, healthcare system, geography, and interactions with broader society

distal context

care that is respectful and responsive to individual patient preferences, needs, and values, ensuring that patients values guide all clinical decisions

patient-centred care definition

a research paper that reviews the research evidence on a particular question

systematic review

the integration of best research evidence, with clinical expertise, and patient values

evidence-based medicine

beneficence, non-maleficence, devotion to the practice of medicine, respect teachers and teach others, respect life, refer to others more skilled, practice confidentiality, honour the social contract

key features of the Hippocratic oath

major source of systematic reviews

Cochrane Collaboration

when a health provider overlooks the context of an individual patient that is essential to managing their problem

contextual error

a patients competence

threshold element details

disclosure of information, understanding of information

information element details

voluntariness, authorisation

consent element details

any clinical decision for a child should be made in the child’s best interest, and take into consideration the family as a whole and potential damage to individual or family by overriding a parental decision

clinical decisions around children and parental discretion

universal, inherent, inalienable, indivisible and interdepent

human rights (5)

when one’s actions are a result of one’s own choices and decisions

autonomy

one ought to do or promote good, one ought to prevent and remove evil or harm

beneficence

primum non nocere, first do no harm, one ought not to inflict evil or harm

non-maleficence

social, distributive, legal

justice

competence, integrity, morality, altruism, promotion of the public good

professionals are members who profess a commitment to:

being honest, moral, consistent, and incorruptible

integrity

putting the individual patients interests first above ones own self interest

altruism

treat all information about patients as confidential, including that a person has been a patient at all

patient confidentiality

notifiable diseases, reporting of child abuse, police warrants/summons

exemptions to patient confidentiality mandated by law

patient is a risk to themselves or harming others, patient discloses they have committed a seriosu crime

exemptions to patient confidentiality in the public interest

the only justification for restricting an individuals liberty against their will is to prevent serious harm

Mill’s Harm Principle

principle-based, virtue-based, moral-based, consequentialist-based

four philosophical arguments for confidentiality

reporting impaired doctors, conflicts of interest

challenges to professionalism

when a doctor entrusted with acting in the best interest of patients also has financial, professional, or personal interests which may affect their care of the patient

conflict of interest

descriptive and analytical studies that usually involve larger population sizes, where the results are usually assessed using statistical methods

quantitative studies

descriptive studies that usually involve a select and small group of people

qualitative studies

the researcher studies but does not alter what occurs

observational studies

the researcher intervenes and then observes what happens

interventional or experimental studies

case study, case series, cross-sectional survey

examples of descriptive quantitative studies

study of one patient that describes them and their disease, may generate a hypothesis about an association between exposure and disease

case study

a study of a small collection of cases with common characteristics, with the aim to describe common features and generate a hypothesis about exposure and disease, cannot confirm nor prove a hypothesis

case series

a study that analyses data from a population at a single point in time

cross-sectional survey

describe or measure the effects of risk factors or the health effects or specific exposures, used to test hypotheses or causal relationships

analytical studies

cohort, case-control

types of analytical studies

exposure is the study factor and disease is the outcome

finding people who are exposed to something and identifying if they have a disease or common outcome

cohort studies

disease is the study factor and exposure is the outcome

finding people who have a disease and identifying if they have an exposure in common

case-control studies

type of prospective cohort study and interventional study, considered the standard for interventional studies

randomised controlled trial

study participants are randomly allocated to comparison groups

randomised

confounders are controlled by the process of randomisation, the study has a comparison or control group

controlled

refers to interventional studies, where researchers give a treatment or intervention to one group and compare it to another group

trial

occurs when there is an apparent association between a presumed exposure and an outcome, but it is instead accounted for by a third variable not on the postulated causal pathway

confounding

restriction, matching, randomisation, statistical methods

ways to minimise confounding

in-built and repeated error in the design, conduct, and analysis of a study that results in a mistaken estimate of the true relationship between an exposure and an outcome

bias

confounding, selection bias, information bias

three main types of bias

occurs when the way that people are selected into the study distorts the estimate of association

selection bias

occurs when information is collected differently between two groups leading to an error in making an association

information bias

prevents information bias in intervention studies

blinding

where the study participants or the investigators do not know which arm of the study they are involved in

single blinding

both the study participants and the investigators do not know which participants received the intervention or the control

double blinding

where both the study participants and the investigators do not know which arm of the study they are involved in

unblinded

looks at the number of new cases arising in a given period of time

incidence

looks at the number of existing cases in a given period of time

prevalence

total number of cases divided by the total population

prevalence calculation

number of new cases over a period of time divided by the number of people at risk

incidence calculation

the probability that an individual will develop a disease in a specified period of time

absolute risk/cumulative incidence

a ratio of cumulative incidences in the exposed and unexposed

CIe/CI0 = ratio of cumulative incidence

a/(a+b) / c/(c+d)

relative risk/risk ratio

suggests that the risk of disease may be increased as a result of that exposure

RR>1

suggests that the risk of disease may be decreased as a result of that exposure

RR<1

the risk of disease in the exposed and unexposed groups is equal

RR=1

measure of association in case-control studies

odds ratio

(exposed cases / not exposed cases) / (exposed controls / not exposed controls)

odds ratio calculation

suggests that exposure may increase the risk of disease

OR>1

suggests that exposure may reduce the risk of disease

OR<1

odds of exposure are equal, exposure is unlikely to be related to disease development

OR=1

the probability that the result observed in the sample data is due to chance

p-value

p value is less than or equal to 0.05

statistically significant result, reject the null hypothesis

estimate of the range in which the true value lies

95% confidence interval

national policies, medicare, PBS, community controlled ATSI primary healthcare, private health insurance, health services for veterans, national health and medical research council, medicines, devices, blood

australian government healthcare roles

public hospitals, license private hospitals, public community based and primary health services, preventative services ambulance services, handling health complaints

state and territory government healthcare roles

environmental health-related services, some community and home based health and support services, some public health and health promotion actvities

local government healthcare roles

health workforce, education/training health professionals, regulation of pharmaceuticals, improvements in safety/quality of healthcare, funding public health programs, funding ATSI health services

shared healthcare roles

2% of taxable income for almost all taxpayers

medicare levy

additional 1-1.5% for high income earners without private health insurance cover

medicare levy surcharge

fee for a given service set by the australian government

schedule fee

suggested fees set by the AMA as a guide for doctors

recommended fee

difference between medicare benefit and schedule fee

gap amount

difference between medicare benefit and what the clinician charges

out-of-pocket costs

where a doctor accepts the medicare benefit as full payment

bulk-billing

provides families and individuals with financial assistance for high costs for out-of-hospital medicare benefits schedule services once they meet a medicare safety net threshold

the medicare safety net

100% schedule fee for GP services

85% schedule fee for other out-of-hospital services

75% schedule fee for in-hospital services

medicare benefits

$7.70

PBS concessional beneficiaries co-payment

$277.20 and free thereafter

PBS safety net threshold

$25.00

PBS general beneficiaries co-payment

$1748.20 and concessional thereafter

PBS safety net threshold

support, advocacy, research, education, service provision, policy, awareness

community health organisation services

health protection, disease prevention, health promotion

three different ways of prevention of disease