Symptom cluster of emotional distress, fatigue and cognitive difficulties among young and older breast cancer survivors: The mediating role of subjective stress.

OBJECTIVES: To examine the nature of the symptom cluster of emotional distress, fatigue, and cognitive difficulties in young and older breast cancer survivors (BCS); To assess the mediating role of subjective stress and coping strategies (emotional control and meaning-focused coping) in the association between age and symptom cluster. MATERIALS AND METHODS: Participants were 170 BCS, stages I-III, 1-12 months post-chemotherapy, filled-out the Fatigue, Emotional Control, Meaning-focused Coping, Emotional Distress and the Cognitive Difficulties Questionnaires. Statistical analyses included tests for difference between-groups Pearson correlations and Structural Equation Modeling for the assessment of the study model. RESULTS: Older BCS (aged 60-82) reported lower levels of emotional distress (M = 0.87, SD = 0.87), fatigue (M = 3.85, SD = 2.38), and cognitive difficulties (M = 1.17, SD = 1.07) compared to the younger BCS (aged 24-59) (emotional distress M = 1.17, SD = 0.85, fatigue M = 5.02, SD = 2.32, and cognitive difficulties M = 1.66, SD = 1.23, p < .01-,05). The older survivors reported lower levels of subjective stress and used more emotional control strategies compared to the younger BCS. The empirical model had good fit indices (χ2 = 27.60, p = 0.20, χ2/df = 1.26; CFI = 0.98; TLI = 0.98; NFI = 0.95; RMSEA = 0.04 (90% CI = 0.00, 10) and showed that subjective stress, but not coping strategies, mediated the effect of age on symptom cluster severity. CONCLUSIONS: Lower levels of subjective stress, but not coping strategies, mediated the association of age with the symptom cluster of emotional distress, fatigue and cognitive difficulties. Further research is needed to explore differences in subjective stress by age.

Hygiene partnering, Part 2.

Today's technology is full of magic and delight in the hygiene arena. Throughout the years, dental hygiene has shifted into a thriving career, and hygienists have welcomed the new role with open arms. Innovation, technology, and partnering have also taken the concept of codiagnosis and comprehensive care to a higher level in the hygiene department. These benefits, combined with more sophisticated patient-centered communication skills and team-centered management philosophies will, without doubt, secure the future of dental hygiene departments in practices worldwide. Moreover, smart practices remaining committed to attracting, training, and retaining only high-caliber staff with interdependent, overlapping talent will find the most reward in helping their patients achieve and maintain optimum oral health for a lifetime.

Total cycle care: balancing patient and employee needs.

Providing a friendly experience during patients' first visits and excellent dental care thereafter is not enough to secure long-term relationships. The best route for continuously providing the best dental experience includes empowering employees so that with their enthusiasm for the practice, they become ambassadors to the practice. Likewise, the team's ability to optimize techniques designed to increase patient comfort will ensure patients' continuing trust.