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Articles 1 - 30 of 52
Full-Text Articles in Medicine and Health Sciences
Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan
Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan
Rowan-Virtua Research Day
Diabetes is a chronic health condition that hinders the body’s metabolic process using insulin to maintain glycemic homeostasis. It is prevalent worldwide, with about 10% of the global adult population affected. Socio-economic and cultural factors and determinants make diabetes and diabetes management more of a health risk for certain populations rather than others. The prevalence of diabetes in the United States is higher than the global average and the risk factors disproportionately affect disadvantaged communities.
This study was designed to investigate health disparities in diabetes among a diverse population sample. The study included researching the disparities of diabetes patients in …
The Impact Of Patient And Provider Education On Statin Therapy Initiation And Adherence In Type Ii Diabetics, Jane Harlan Bsn-Rn, Lindsey Jacobsen Bsn-Rn, Emily Easterly Bsn-Rn, Mitch King Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne
The Impact Of Patient And Provider Education On Statin Therapy Initiation And Adherence In Type Ii Diabetics, Jane Harlan Bsn-Rn, Lindsey Jacobsen Bsn-Rn, Emily Easterly Bsn-Rn, Mitch King Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne
Doctor of Nursing Practice Projects
Purpose/Background
Type 2 diabetes mellitus (T2DM) is a common, chronic disease that increases the risk of coronary artery disease and stroke fourfold, which makes protecting cardiac function a priority. The American Diabetes Association (ADA) and American Heart Association (AHA) recommend the prescription of statins to reduce cardiovascular complications. Unfortunately, provider and patient adherence to this recommendation is poor.This study aimed to determine if shared-decision making and patient follow-up within a 6 month period of being newly diagnosed with T2D has an effect on the initiation rate of statin therapy.
Methods
In this retrospective study we requested data from the University …
Effect Of Certified Diabetes Clinical Education Specialists On Adults With Type 2 Diabetes, Rachel Faller, Tracy Gregory, Michelle Jones, Peyton Barnett, Laura Reed Dnp, Aprn, Fnp-Bc, Cne
Effect Of Certified Diabetes Clinical Education Specialists On Adults With Type 2 Diabetes, Rachel Faller, Tracy Gregory, Michelle Jones, Peyton Barnett, Laura Reed Dnp, Aprn, Fnp-Bc, Cne
Doctor of Nursing Practice Projects
Purpose/Background
Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can …
Use Of A Primary Care Dataset To Describe ‘The Real Picture’ Of Diabetes In Kimberley Aboriginal Communities, Caitlyn S. White, Kimberley Seear, Lorraine Anderson, Emma Griffiths
Use Of A Primary Care Dataset To Describe ‘The Real Picture’ Of Diabetes In Kimberley Aboriginal Communities, Caitlyn S. White, Kimberley Seear, Lorraine Anderson, Emma Griffiths
Journal of the Australian Indigenous HealthInfoNet
Objective
Aboriginal communities are impacted by high rates of diabetes, however these are currently underestimated by national data sources used by policy and decision makers to inform allocation of health resources. We aimed to estimate diabetes prevalence and screening coverage using primary care electronic medical record data.
Methods
A cross-sectional audit was conducted using primary care data from Aboriginal regular Aboriginal Community Controlled Health Service (ACCHS) clinic attendees aged 15 years and over (n=1763) in five remote communities in the Kimberley region. Main outcome measures were overall diabetes prevalence; age-specific diabetes prevalence; prevalence of pre-diabetes; and screening rates among patients …
Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso
Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso
Master's Projects and Capstones
Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.
Context: The endocrinology clinic serves a patient population, …
Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey
Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey
Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)
Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …
The Impact Of Kentucky’S Medicaid Expansion On Adult Coverage And Diagnosis Of Type 2 Diabetes Mellitus And Diabetic Peripheral Neuropathy, The Use Of Antihyperglycemics And The Role Of Social Determinants Of Health 2011-2018., Brian Mcroberts
Electronic Theses and Dissertations
Objectives: This study analyzed the impact of Medicaid expansion in Kentucky on coverage of adults aged 19-64 and the diagnosis of type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) and the use of antidiabetic medications or insulin (antihyperglycemics) for T2DM, controlling for Social Determinants of Health (SDOH). Method: This study assembled ICD-based claims and prescription drug NDC claims from all adult residents of Kentucky enrolled in Medicaid from 2011 to 2018. Three-digit zip code (Zip-3) data was appended to each case from the American Community Survey to provide SDOH variables. Tests performed included ANOVA, decision trees, varimax rotated …
The Impact Of County Level Characteristics On Type 2 Diabetes Related Ed Utilization, Jessica Wilson
The Impact Of County Level Characteristics On Type 2 Diabetes Related Ed Utilization, Jessica Wilson
MUSC Theses and Dissertations
Approximately 90-95% of the more than 37 million American adults who are living with diabetes have type 2 diabetes. Additionally, those living in rural areas face poor health outcomes related to chronic diseases such as diabetes. The impact of factors related to social determinants of health such as the role of rurality and social vulnerability were described by examining county diabetes related Emergency Department (ED) visit rates for adults aged 18-25 living in North Carolina. No difference in county level diabetes related ED visits were observed between rural counties vs. nonrural counties in the state. However, patterns did emerge in …
Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr
Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr
Walden Dissertations and Doctoral Studies
AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Walden Dissertations and Doctoral Studies
Diabetes imposes a major burden on society, especially in the state of Florida, in the form of increased medical costs, lost productivity, early mortality, and intangible costs in the form of diminished quality of life. Access to diabetic care affects health administration in Florida by impacting the overall cost of treating the condition. Limited access to care can lead to an increased risk of complications resulting in a higher cost of treatment. The purpose of this quantitative study was to determine whether access to care dependent variables (access to doctors and length of time since last routine checkup) were associated …
Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr
Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr
Walden Dissertations and Doctoral Studies
AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker
Walden Dissertations and Doctoral Studies
Diabetes imposes a major burden on society, especially in the state of Florida, in the form of increased medical costs, lost productivity, early mortality, and intangible costs in the form of diminished quality of life. Access to diabetic care affects health administration in Florida by impacting the overall cost of treating the condition. Limited access to care can lead to an increased risk of complications resulting in a higher cost of treatment. The purpose of this quantitative study was to determine whether access to care dependent variables (access to doctors and length of time since last routine checkup) were associated …
September 2022, Swosu Bulldog Wellness Committee
September 2022, Swosu Bulldog Wellness Committee
SWOSU BULLDOG WELLNESS
National Childhood Obesity Awareness Month
About 1 in 5 American children has obesity. Compared to children with healthy weight, children with overweight or obesity are at a higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes, and heart disease.
Efficacy Of Various Interventions For Achieving Target Hba1c Levels For Patients With Type Ii Diabetes Mellitus And On Exogenous Insulin, Caitlin S. Welch, Archie Troxel
Efficacy Of Various Interventions For Achieving Target Hba1c Levels For Patients With Type Ii Diabetes Mellitus And On Exogenous Insulin, Caitlin S. Welch, Archie Troxel
Longitudinal Scholar's Project
Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals.
Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD …
Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc
Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc
Doctor of Nursing Practice Projects
Purpose/Background: By reviewing multiple studies related to the treatment of patients with new diagnoses of diabetes, this scoping review will endeavor to determine which interventions, when implemented for patients over 50 years old which are newly diagnosed with type 2 diabetes, can decrease the likelihood of hospital readmission related to diabetes within 90 days when compared with those patients who did not receive or participate in follow-up.
Methods: For resources to be eligible to review they had to be from 2015 or after. Studies selected included patients over the age of 50 newly diagnosed with type 2 diabetes subject to …
Using Digital Storytelling To Assess Patient Experience With Management Of Diabetes In Everyday Life (Model) Study Intervention, Arati Joshi
Longitudinal Scholar's Project
African Americans are disproportionately affected by obesity-associated diabetes compared to their White counterparts. While social determinants of health may contribute to their poor health outcomes, studies have shown that pragmatic primary care-based interventions can be effective in improving the management of obesity-associated diabetes. The Management of Diabetes in Everyday Life (MODEL) is a pragmatic randomized comparative effectiveness trial of three approaches (health coaching, text-messaging, and enhanced usual care) to supporting medically underserved African American patients with uncontrolled diabetes in improving their self-care decisions. The purpose of this study is to assess the effect of the MODEL program participation on the …
Medicine Adherence As A Determinant Of Complication Development In Diabetes And Hypertension Patients On A Medical Aid Scheme In Zimbabwe, Tsitsi Moyo
Walden Dissertations and Doctoral Studies
Pharmacotherapy is a significant component of chronic disease management; its efficacy depends on long term, correct, and consistent use; however, medicine adherence rates remain low. The cost of medicines is considered a significant barrier to adherence, especially in low-income settings. This quantitative cross-sectional study was conducted using data from Cimas Medical Aid Society collected between 2015 and 2019. The purpose of the study was to determine the extent of the association between medicine adherence, complication development, and cost of care among diabetic and hypertensive patients while controlling for age and gender on a population that does not experience cost barriers …
Nursing Staff Education On The Use Of The American Diabetes Association Guidelines, Terrie Hattie Allen
Nursing Staff Education On The Use Of The American Diabetes Association Guidelines, Terrie Hattie Allen
Walden Dissertations and Doctoral Studies
AbstractDiabetes mellitus is a complex chronic condition that requires continuous care and management. Approximately 34 million Americans are diagnosed with diabetes and around 90%–95% suffer from Type 2 diabetes. The problem identified in this project was the need to follow the American Diabetes Association guidelines in place at the study site clinic but are not adhered to by the staff. Framed within the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this project was to plan, implement, and evaluate a nursing staff education program on the use of the American Diabetes Association Guidelines for diabetes. …
Medicine Adherence As A Determinant Of Complication Development In Diabetes And Hypertension Patients On A Medical Aid Scheme In Zimbabwe, Tsitsi Moyo
Walden Dissertations and Doctoral Studies
Pharmacotherapy is a significant component of chronic disease management; its efficacy depends on long term, correct, and consistent use; however, medicine adherence rates remain low. The cost of medicines is considered a significant barrier to adherence, especially in low-income settings. This quantitative cross-sectional study was conducted using data from Cimas Medical Aid Society collected between 2015 and 2019. The purpose of the study was to determine the extent of the association between medicine adherence, complication development, and cost of care among diabetic and hypertensive patients while controlling for age and gender on a population that does not experience cost barriers …
November 2021, Swosu Bulldog Wellness Committee
November 2021, Swosu Bulldog Wellness Committee
SWOSU BULLDOG WELLNESS
November is American Diabetes Month®
Approximately 373,824 people in Oklahoma have diagnosed diabetes.
An estimated 1,040,000 people in Oklahoma have prediabetes. Take the following survey to find your risk for type 2 diabetes. You will also be given the opportunity to request to be contacted by the SWOSU College of Pharmacy Rural Health Diabetes Prevention Program for upcoming group classes.
Type 2 Diabetes Risk Test: https://swosu.formstack.com/forms/prescreening_questionnaire_dpp
September 2021, Swosu Bulldog Wellness Committee
September 2021, Swosu Bulldog Wellness Committee
SWOSU BULLDOG WELLNESS
SWOSU is holding COVID19 Vaccination Clinics on Fridays
through the months of September and October
10 am – 2 pm at the Pioneer Cellular Event Center
• This is open to all students and faculty
• Public walk-ins are welcome
**Appointments are not required, but helpful for vaccine management**
• For questions, call the SWOSU COVID phone line 580-774-3025
Evaluating A1c Reduction In Patients With Diabetes Receiving Pharmacy Intervention, Christopher R. Evans, Kirsten Held, Stephanie Thomas, Jeanne Spencer
Evaluating A1c Reduction In Patients With Diabetes Receiving Pharmacy Intervention, Christopher R. Evans, Kirsten Held, Stephanie Thomas, Jeanne Spencer
Advances in Clinical Medical Research and Healthcare Delivery
Introduction: Diabetes affects 34 million Americans and is the 7th leading cause of death in the United States. According to the American Diabetes Association (ADA) the A1c goal for most patients is less than 7%; however, in patients at risk for hypoglycemia or with complications that goal can be increased up to less than 8%. Management of diabetes with diet and exercise is essential, but insufficient for most patients and pharmacologic intervention is necessary to achieve therapeutic goals. Reducing A1c is associated with lower cardiovascular risk and a reduction in diabetes-associated complications. Previous studies have shown that pharmacist management of …
The Effect Of Nurse Case Coordination On Management Of Chronic Conditions, Aayush Mittal Ms-Hsm
The Effect Of Nurse Case Coordination On Management Of Chronic Conditions, Aayush Mittal Ms-Hsm
Clinical Research in Practice: The Journal of Team Hippocrates
A clinical decision report using:
Ishani A, Greer N, Taylor BC, et al. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial. Diabetes Care. 2011;34(8):1689-1694. https://doi.org/10.2337/dc10-2121
for a patient requiring care coordination for management of hypertension, diabetes, and hyperlipidemia.
Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo
Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo
Theses and Dissertations (ETD)
Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …
Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish
Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish
Doctor of Nursing Practice (DNP) Projects
Continuous Glucose Monitoring and Diabetes Management During Pregnancy
Abstract
According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …
Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman
Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman
Electronic Theses and Dissertations
Each year, Americans spend more money on health care than any other industrialized nation, despite comparable mortality rates for people with risk factors for heart disease. The reasons for this lack of health care value in the US are numerous and complex – including market distortions like supplier-inflated pricing and regulatory structures that enable consumers to utilize ubiquitous, high-cost medical technologies that yield uncertain benefits. Health insurance, once thought to be an insignificant contributor to rising health spending, has changed considerably in the past few decades in ways that make it more accessible and more generous in coverage. Health insurance …
The Determinants Of Physical Activity, Self-Monitoring Of Blood Glucose, And Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes In Saudi Arabia: A Cross-Sectional Study Based On The Saudi Health Interview Survey (Shis), Mohammed Abdulrahman S. Alsuliman
The Determinants Of Physical Activity, Self-Monitoring Of Blood Glucose, And Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes In Saudi Arabia: A Cross-Sectional Study Based On The Saudi Health Interview Survey (Shis), Mohammed Abdulrahman S. Alsuliman
Health Services Research Dissertations
The prevalence of diabetes and poor glycemic control in Saudi Arabia has increased that contributed to the growing number of deaths in Saudi Arabia. It is known that type 2 diabetes (T2DM) can be prevented but there is a lack information about the magnitude of the of diabetes at national level as well as the risk factors for physical activity (PA), self-monitoring of blood glucose (SMBG), and poor glycemic. Thus, through utilizing Health promotion model (HPM), the aims are to examine the personal factors, cognitive-perceptual, and behavioral determinants of three outcomes; physical activity, SMBG, and poor glycemic control. A secondary …
Diabetes As It Relates To Stress, Anxiety And Lifestyle Choices, Kayla C. Dedloff
Diabetes As It Relates To Stress, Anxiety And Lifestyle Choices, Kayla C. Dedloff
2020 Symposium Posters
Type 2 diabetes is a chronic condition that impacts 29 million people in the United States. Diabetes is a disease that develops when one's body becomes resistant to insulin, resulting in abnormal metabolism of carbohydrates, and the blood glucose levels are increased. If hyperglycemia is not managed, it will result in complications. Management of stress is significant in diabetic patients because stressing intensifies diabetes. The majority of type 2 diabetes patients are overwhelmed with managing the disease, and when they can’t control their blood glucose, it results in depression and anxiety. There is a link between lifestyle choices and type …
A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser
A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser
Evidence-Based Practice Project Reports
In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …
Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn
Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn
Evidence-Based Practice Project Reports
Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …