Using the attached form, complete this weeks reflections related to your readings, assignments, and implications for current or future practice. 

Reflective Journal Rubric

20 pts

Exemplary

Developing

Needs Improvement

Discussion Criteria

10 Points

7 Points

4 Points

Faculty Comments

Application of Course Knowledge 

Journal contributes reflections and unique perspectives or insights gleaned from weekly objectives or examples from the healthcare field.

Journal entry has limited application of course knowledge and demonstration of perspectives.

Journal does not reflect application of course knowledge and personal insights or examples from healthcare.

Grammar, Syntax, APA Format

APA format, grammar, spelling, and/or punctuation are accurate, or with zero to three errors.

Four to six errors in APA format, grammar, spelling, and syntax noted.

Journal entry contains greater than six errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback.

Reflective Journal

Name:

Date:

1. Summarize and reflect on this week’s, readings and learning activities.

2. How will these concepts impact your own professional practice now or in the future?

Correspondence

www.thelancet.com Vol 388 August 6, 2016 561

sample of people with type 1 and
type 2 diabetes was seven times
higher (14·3%) than in the general
p o p u l a t i o n ( 2 · 3 % ) . Pa r t i c i p a n t s
with insulin-treated type 2 diabetes
reported more frequent depressive
symptoms (34.3%) and even more
prevalent suicidal ideation (19%)
than individuals with type 1 diabetes.
Participants with diabetes and at
least moderate depressive symptoms
reported higher suicide ideation rates
(>40%) than those with diabetes and
no depressive symptoms (5·8%).3
The suicide rate in young men (ages
20–24 years) with type 1 diabetes is
complex, understudied, and higher
than the expectations of Kyvik and
colleagues, 4 suggesting that the
cause of death is often misclassifi ed
as diabetes-related, rather than
due to mental health issues or
suicide. Depression is associated
with increased mortality in diabetic
populations. Similarly, depressive
symptoms have been shown to
increase mortality risk in people with
diabetes but not in those without
diabetes.5

These pieces emphasise the eff ect of
mental health on diabetes, and further
ignorance will o

nl

y lead to increasing
numbers of articles chronicling the
ballooning costs of the diabetes
epidemic.
We declare no competing interests.

*Gemma C Macdonald,
Lesley V Campbell
gemma.macdonald@svha.org.au

Diabetes Centre, St Vincent’s Hospital, Sydney,
NSW 2010, Australia

1 Krug EG. Trends in diabetes: sounding the
alarm. Lancet 2016; 387: 1485–86.

2 Vigo D, Thornicroft G, Atun R. Estimating the
true global burden of mental illness.
Lancet Psychiatry 2016; 3: 171–78.

3 Handley TE, Ventura AD, Browne JL, et al. Suicidal
ideation reported by adults with Type 1 or Type 2
diabetes: results from Diabetes MILES-Australia.
Diabet Med 2015; published online Nov 3, 2015.
doi: 10.1111/dme.13022.

4 Kyvik KO, Stenager EN, Green A, Svendsen A.
Suicides in men with IDDM. Diabetes Care
1994; 17: 210–12.

5 Zhang X, Norris SL, Gregg EW, Cheng YJ,
Beckles G, Kahn HS. Depressive symptoms and
mortality among persons with and without
diabetes. Am J Epidemiol 2005; 161: 652–60.

Division of Neonatology, Erasmus University
Medical Centre, Sophia Children’s Hospital,
Rotterdam, the Netherlands (JVB); Centre of
Medical Informatics, Usher Institute of Population
Health Sciences and Informatics, The University of
Edinburgh, Edinburgh, UK (JVB, AS); and School for
Public Health and Primary Care (CAPHRI),
Maastricht University Medical Center, Maastricht,
Netherlands (JVB, AS)

1 GBD Risk Factors Collaborators. Global, regional,
and national comparative risk assessment of
79 behavioural, environmental and occupational,
and metabolic risks or clusters of risks in
188 countries, 1990–2013: a systematic analysis
for the Global Burden of Disease Study 2013.
Lancet 2015; 386: 2287–323.

2 Flenady V, Koopmans L, Middleton P, et al.
Major risk factors for stillbirth in high-income
countries: a systematic review and
meta-analysis. Lancet 2011; 377: 1331–40.

3 Aune D, Saugstad OD, Henriksen T, Tonstad S.
Maternal body mass index and the risk of fetal
death, stillbirth, and infant death: a systematic
review and meta-analysis. JAMA 2014;
311: 1536–46.

4 Amegah AK, Quansah R, Jaakkola JJ. Household
air pollution from solid fuel use and risk of
adverse pregnancy outcomes: a systematic
review and meta-analysis of the empirical
evidence. PLoS One 2014; 9: e113920.

5 US Department of Health and Human Services.
The health consequences of smoking—50 years
of progress: a report of the Surgeon General.
Rockville, MD: US Department of Health and
Human Services, 2014.

Mental illness: the
forgotten burden on
diabetes populations?

In April, The Lancet discussed the high
cost of diabetes and an urgent call for
action. The Comment by Etienne Krug
(April 9, p 1485)1 focuses on physical
interventions without mentioning the
burden of mental illness in diabetes,
in which depression and diabetes
distress are common. Depression also
has a bidirectional relationship with
type 2 diabetes, showing causative and
consequential implications: mental
health is an essential consideration in
diabetes prevention and management.

The 2011 UN initiative aims to
r e d u c e p r e m a t u r e d e a t h s f r o m
non-communicable diseases. Vigo
and colleagues 2 warned of large
numbers of people with severe
mental illness dying prematurely
from non-communicable diseases.
S u i c i d a l i d e a t i o n i n a l a r g e

Freedom of expression
and health: is the
association causal?

Article 19 of The Universal Declaration
of Human Rights1 declares the right to
freedom of opinion and expression as
one of the fundamental human rights.
The violation of human rights deserves
condemnation by civilised society.
Health-care workers are entrusted with
the task of mitigating pain in all forms,
and preventing premature death
due to all causes. Clearly, homicide
deserves the highest condemnation
by physicians as members of civilised
society. Physical or mental harming
of individuals for their expression of
contrary views by organised groups is
the worst form of humanity; it refl ects
the distortion of collective wisdom.

However, the condemnation of such
events by The Lancet (May 7, p 1880)2
needs more caution. The scientific
community is testing ways to study the
relations between human rights and
health at present,3 and evidence of an
association between the two is under
investigation. To upgrade one domain of
human rights—ie, the right to freedom—
to causal of health, is premature. The
Lancet manifesto reads “Improving
lives is the only end goal that matters”,
but there is a fl ipside: the aim is to be
achieved through scientific principles.
We as professionals should not attempt
to achieve our objectives through means
other than evidence, delivered by robust
research. In the long term it may be
deleterious both for the science, and the
success of the mission.
I declare no competing interests.

Varun M Malhotra
varunmalho3ra@gmail.com

Department of Community Medicine, Kamineni Institute
of Medical Sciences, Narketpally, Telangana 508254, India

1 The Universal Declaration of Human Rights.
UN. www.un.org/en/universal-declaration-
human-rights/ (accessed May 8, 2016).

2 The Lancet. No free expression, no health.
Lancet 2016; 387: 1880.

3 Hunt P, Yamin AE, Bustreo F. Making the case:
what is the evidence of impact of applying
human rights-based approaches to health?
Health Hum Rights 2015; 17: 1–10.

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• Freedom of expression and health: is the association causal?

References