Social isolation and social connectedness among young adult cancer survivors: A systematic review.

BACKGROUND: Social isolation and connectedness are social determinants of health that have demonstrated effects on cancer-related outcomes. These constructs have been systematically evaluated among pediatric and older adult cancer populations. In this review, the authors evaluated the prevalence, correlates, and psychosocial implications of social isolation and connectedness among young adult (YA) cancer survivors aged 18-39 years. METHODS: Peer-reviewed articles published in English before June 2021 were identified from database searches and included articles' reference lists according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included articles described studies that assessed social isolation and/or connectedness among YA cancer survivors. RESULTS: In total, 5094 unique records were identified; 4143 were excluded after title/abstract screening, and 907 were excluded after full-text review. Forty-four articles were included. Few studies used validated measures or directly assessed social isolation or connectedness. Social isolation was similarly prevalent among YAs and older cancer survivors and noncancer populations. Demographic, clinical, and behavioral risk and protective factors for social isolation were identified. Social isolation was related to worse psychological well-being, whereas social connectedness was often, but not always, related to better psychological well-being. CONCLUSIONS: This growing literature underscores the relevance of social isolation and connectedness as important health determinants among YA cancer survivors. The identified risk and protective factors can identify YAs who especially may benefit from screening for social isolation. Future studies are needed that directly, reliably, and validly evaluate social isolation and connectedness to inform the development of interventions to decrease isolation and increase connectedness.

Daily association of stressors with perceived cognitive performance: Moderating role of age.

Stress can elicit both positive and negative impacts on cognition. Less is known about whether and how daily stressors are associated with perceived cognitive performance in healthcare workers. We examined daily associations between stressors and perceived cognitive performance in nurses and whether these associations differed by age or nursing tenure. Using 14-day smartphone-based ecological momentary assessment, 60 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents). Each day, participants subjectively evaluated their mental focus, memory, and processing speed. Multilevel modelling examined the within- and between-person associations of daily stressors with cognitive performance. More stressors were associated with poorer perceived cognitive performance at both within- and between-person levels for both daily stressor frequency and severity. For moderation by age, the within-person stressor severity-cognitive performance relationship was only significant for nurses who were younger, but not for those who were older. Similarly, the within-person associations of daily stressor frequency and severity with cognitive performance were only significant for nurses with a shorter tenure. Findings suggest daily stressors may degrade perceived cognitive performance in nurses and the impact may be stronger for those who are younger or with less experience on the job.

Considerations for developing supportive care interventions for survivors of head and neck cancer: A qualitative study.

OBJECTIVE: This study aimed to describe considerations for developing supportive care interventions targeted to head and neck cancer (HNC) survivors. METHODS: One-time semi-structured interviews (N = 33) were conducted with HNC survivors who had recently finished treatment (n = 20) and HNC providers (e.g., physicians, nurses; n = 13). Interviews were transcribed verbatim and coded using inductive applied thematic analysis techniques to identify themes. RESULTS: HNC survivors (75% male; M = 61 years old) and providers (54% physicians; 62% female) were unanimously supportive of developing HNC-specific supportive care interventions. Participants described potential benefits of offering interventions at various points throughout the HNC treatment and survivorship trajectory rather than at a single critical time. Many participants preferred group-based interventions because of the high value of peer-support. Others described how group interventions may not be appropriate for all HNC survivors due to risks for negative social comparisons and exacerbated anxiety. Participants suggested topics that should be addressed in HNC-specific interventions including education about acute and long-term side effects, symptom management, nutritional support, relationship/social role changes, grief/loss, and fear of recurrence. CONCLUSIONS: HNC-specific supportive care interventions are critically needed, as survivors experience persistent symptoms and distinct psychosocial concerns that impact quality of life. Findings from this study can inform the development of supportive care interventions targeted to the unique psychosocial concerns of HNC survivors.

Adapting Research to a Global Pandemic: A Fully Remote Actigraphy and Ecological Momentary Assessment Study.

BACKGROUND: Mandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality. OBJECTIVES: We aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days. METHODS: Using an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences. RESULTS: Adherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting "easy, clear, simple onboarding" and 16.3% reporting the website was "helpful." Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses. DISCUSSION: Findings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

Daily associations between sleep and stressors in nurses with and without children.

Previous research shows that adults with children have poorer sleep overall than adults without children. Poorer sleep is associated with experiencing more frequent and severe stressors. The daily link between sleep and stressors may differ by parenting status; yet this potential difference has not been addressed, especially in nurses who provide care both at work and home. This study examined whether the sleep-stress relationship is stronger for nurses with children than those without. During 14 days of ecological momentary assessment, 60 hospital nurses (24 parents) reported their previous night's sleep characteristics upon waking. Three times daily, they also reported whether they encountered any stressors and how severe those stressors were. Associations were assessed at the within- and between-person levels with parenting status as a between-person moderator. After controlling for covariates, previous night's poorer sleep quality, lower sleep sufficiency, and shorter time in bed were associated with perceiving more frequent or severe stressors the following day. Some of these daily associations were moderated by parenting status, such that the sleep-stressor link was only significant for parents, with the magnitude of association being stronger for those with 2+ children relative to 1 child. These findings suggest that nurses with children are at greater risk for a stronger linkage between poorer sleep and greater stressor frequency and severity. A stronger sleep-stressor relationship could have compounding effects on health. Improving sleep in this group may be critical to reduce their stress and improve the quality of care across work and home.

Individual and joint associations of daily sleep and stress with daily well-being in hospital nurses: an ecological momentary assessment and actigraphy study.

Sleep and stress are predictors of daily physical and emotional well-being, but few studies assess both simultaneously. This study examined individual and joint associations of daily sleep and stress with daily well-being (DWB) in hospital nurses. Nurses (n = 60) participated in a 14-day ecological momentary assessment and actigraphy study. Multilevel modeling revealed associations of stressor severity and poor sleep health with DWB, independent of and coupled with each other, at within- and between-person levels. Greater stressor severity or poorer sleep health, independent of each other, were associated with more physical symptoms, less positive affect (PA), and more negative affect (NA). Joint associations of stress and sleep with DWB were observed: PA was lowest when higher stressor severity was coupled with poorer sleep health; NA was lowest when lower stressor severity was coupled with better sleep health. Findings suggest the importance of considering both sleep and stress for DWB in hospital nurses.

Job Strain and Late-Life Cognition: Findings From the Puerto Rican Elderly Health Conditions Study.

Objectives: We examined associations between job strain and cognitive aging in a sample of older Puerto Ricans. Methods: Members of the Puerto Rican Elderly: Health Conditions study, aged 60-100 years at baseline, participated. Job strain indicators were quantified from O*NET (n = 1632) and a matrix of Job Content Questionnaire scores (JCQ; n = 1467). Global cognition was assessed twice across 4 years. Results: Controlling for age, sex, depressive symptoms, financial problems, hypertension, diabetes, childhood economic hardship, low job control and high job strain were consistently associated with greater cognitive decline. Adding education attenuated these associations. High education strengthened the JCQ job control-cognitive change link. Discussion: Low job control and high job strain may accelerate cognitive aging in this population. However, it may be more difficult to disentangle the intersecting roles of education and job strain in cognitive aging among older Puerto Ricans relative to older adults from contiguous United States or Europe.

Stressor reactivity to insufficient sleep and its association with body mass index in middle-aged workers.

There is evidence that insufficient sleep and more stressors are individually associated with poor metabolic health outcomes. Examining sleep and stressors jointly may account for greater variability in health outcomes; however, we know little about the combined effect of both insufficient sleep and more stressors on metabolic health. This study examined whether experiencing more stressors in response to insufficient sleep ("stressor reactivity to insufficient sleep") was associated with body mass index in middle-aged workers. One-hundred and twenty-seven participants (Mage  = 45.24 ± 6.22 years) reported nightly sleep characteristics and daily stressors on 8 consecutive days. We collected height and weight measurements to calculate body mass index (kg m-2 ). On average, workers reported more stressors following nights with shorter-than-usual sleep duration or poorer-than-usual sleep quality (negative slope means higher stressor reactivity to insufficient sleep). When examining stressor reactivity to insufficient sleep with insufficient sleep represented by shorter-than-usual sleep duration, compared with those with average stressor reactivity to insufficient sleep (within ±½ SD; reference), workers with high stressor reactivity to insufficient sleep (≤-½ SD) had higher body mass index (B = 3.24, p < .05). The body mass index of these workers fell in the obese range. There was no difference in body mass index between workers with low stressor reactivity to insufficient sleep (≥+½ SD) and the reference group. When examining stressor reactivity to insufficient sleep with insufficient sleep represented by poorer-than-usual sleep quality, stressor reactivity to insufficient sleep was not significantly associated with body mass index. Results suggest that middle-aged workers with higher stressor reactivity to insufficient sleep duration may be at greater risk for obesity. Results may inform future studies on interventions for improving sleep and reducing stress in middle-aged workers.