{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T04:34:28Z","timestamp":1769834068565,"version":"3.49.0"},"reference-count":45,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T00:00:00Z","timestamp":1540944000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/legalcode"}],"content-domain":{"domain":["clinical-practice-and-epidemiology-in-mental-health.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["CPEMH"],"published-print":{"date-parts":[[2018,10,31]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p>Stress is a complex process with an impact on health and performance. The use of wearable sensor-based monitoring systems offers interesting opportunities for advanced health care solutions for stress analysis. Considering the stressful nature of firefighting and its importance for the community\u2019s safety, this study was conducted for firefighters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>A biomonitoring platform was designed, integrating different biomedical systems to enable the acquisition of real time Electrocardiogram (ECG), computation of linear Heart Rate Variability (HRV) features and collection of perceived stress levels. This platform was tested using an experimental protocol, designed to understand the effect of stress on firefighter\u2019s cognitive performance, and whether this effect is related to the autonomic response to stress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method:<\/jats:title><jats:p>The Trier Social Stress Test (TSST) was used as a testing platform along with a 2-Choice Reaction Time Task. Linear HRV features from the participants were acquired using an wearable ECG. Self-reports were used to assess perceived stress levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>The TSST produced significant changes in some HRV parameters (AVNN, SDNN and LF\/HF) and subjective measures of stress, which recovered after the stress task. Although these short-term changes in HRV showed a tendency to normalize, an impairment on cognitive performance was found after performing the stress event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>Current findings suggested that stress compromised cognitive performance and caused a measurable change in autonomic balance. Our wearable biomonitoring platform proved to be a useful tool for stress assessment and quantification. Future studies will implement this biomonitoring platform for the analysis of stress in ecological settings.<\/jats:p><\/jats:sec>","DOI":"10.2174\/1745017901814010250","type":"journal-article","created":{"date-parts":[[2018,11,5]],"date-time":"2018-11-05T09:58:53Z","timestamp":1541411933000},"page":"250-262","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Wearable Biomonitoring Platform for the Assessment of Stress and its Impact on Cognitive Performance of Firefighters: An Experimental Study"],"prefix":"10.2174","volume":"14","author":[{"given":"Susana","family":"Rodrigues","sequence":"first","affiliation":[]},{"given":"Joana S.","family":"Paiva","sequence":"additional","affiliation":[]},{"given":"Duarte","family":"Dias","sequence":"additional","affiliation":[]},{"given":"Gon\u00e7alo","family":"Pimentel","sequence":"additional","affiliation":[]},{"given":"Mariana","family":"Kaiseler","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o Paulo S.","family":"Cunha","sequence":"additional","affiliation":[]}],"member":"965","reference":[{"key":"ref1","unstructured":"Lazarus RS, Folkman S. Stress, coping and adaptation 1984."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00000441-193501000-00001","volume":"189","author":"Cannon W.B.","year":"1935","unstructured":"Cannon WB. Stresses and strains of homeostasis. Am J Med Sci 1935; 189 : 1-14.","journal-title":"Am. J. Med. Sci."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1177\/0956797610384746","volume":"21","author":"Roelofs K.","year":"2010","unstructured":"Roelofs K, Hagenaars MA, Stins J. Facing freeze: Social threat induces bodily freeze in humans. Psychol Sci 2010; 21 (11) : 1575-81.","journal-title":"Psychol. Sci."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3389\/fnbeh.2018.00097","volume":"12","author":"Niermann H.C.M.","year":"2018","unstructured":"Niermann HCM, Figner B, Tyborowska A, Cillessen AHN, Roelofs K. Investigation of the stability of human freezing-like responses to social threat from mid to late adolescence. Front Behav Neurosci 2018; 12 : 97.","journal-title":"Front. Behav. Neurosci."},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1098\/rstb.2016.0206","volume":"372","author":"Roelofs K.","year":"2017","unstructured":"Roelofs K. Freeze for action: Neurobiological mechanisms in animal and human freezing. Phil Trans R Soc B 2017; 372 (1718)","journal-title":"Phil Trans R Soc B."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"5995","DOI":"10.1073\/pnas.1118355109","volume":"109","author":"Cohen S.","year":"2012","unstructured":"Cohen S, Janicki-Deverts D, Doyle WJ, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA 2012; 109 (16) : 5995-9.","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref7","unstructured":"Fenici R, Brisinda D, Sorbo A. Methods for Real-Time Assessment of Operational Stress During Realistic Police Tactical Training 2011."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Carbonaro N, Anania G, Mura GD, Tesconi M, Tognetti A, Zupone G, et al. Wearable biomonitoring system for stress management: A preliminary study on robust ECG signal processing IEEE International Symposium on a World of Wireless, Mobile and Multimedia Networks; 2011; pp. 2011; 20-4.","DOI":"10.1109\/WoWMoM.2011.5986192"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"E2414","DOI":"10.3390\/s18082414","volume":"18","author":"Dias D.","year":"2018","unstructured":"Dias D, Paulo Silva Cunha J. Wearable health devices-vital sign monitoring, systems and technologies. Sensors (Basel) 2018; 18 (8) : E2414.","journal-title":"Sensors (Basel)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.30773\/pi.2017.08.17","volume":"15","author":"Kim H.G.","year":"2018","unstructured":"Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and heart rate variability: A meta-analysis and review of the literature. Psychiatry Investig 2018; 15 (3) : 235-45.","journal-title":"Psychiatry Investig."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1136\/heart.89.3.337","volume":"89","author":"Schwab J.O.","year":"2003","unstructured":"Schwab JO, Eichner G, Schmitt H, Weber S, Coch M, Waldecker B. The relative contribution of the sinus and AV node to heart rate variability. Heart 2003; 89 (3) : 337-8.","journal-title":"Heart"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.bspc.2015.02.012","volume":"18","author":"Castaldo R","year":"2015","unstructured":"Castaldo R, Melillo P, Bracale U, Caserta M, Triassi M, Pecchia L. Acute mental stress assessment via short term HRV analysis in healthy adults: A systematic review with meta-analysis. Biomed Signal Process Control 2015; 18 : 370-7.","journal-title":"Biomed Signal Process Control"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.2174\/1875399X01407010008","volume":"7","author":"Perroni F.","year":"2014","unstructured":"Perroni F, Guidetti L, Cignitti L, Baldari C. Psychophysiological responses of firefighters to emergencies: A review. Open Sports Sci J 2014; 7 : 8-15.","journal-title":"Open Sports Sci. J."},{"key":"ref14","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1002\/smi.2616","volume":"30","author":"Young PM","year":"2014","unstructured":"Young PM, Partington S, Wetherell MA, St Clair Gibson A, Partington E. Stressors and coping strategies of U.K. firefighters during on-duty incidents. Stress and health. Journal of the International Society for the Investigation of Stress 2014; 30 (5) : 366-76.","journal-title":"Journal of the International Society for the Investigation of Stress"},{"key":"ref15","first-page":"134","volume":"76","author":"Leach J.","year":"2005","unstructured":"Leach J. Cognitive paralysis in an emergency: The role of the supervisory attentional system. Aviat Space Environ Med 2005; 76 (2) : 134-6.","journal-title":"Aviat. Space Environ. Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1111\/1469-8986.3960723","volume":"39","author":"Ellenbogen M.A.","year":"2002","unstructured":"Ellenbogen MA, Schwartzman AE, Stewart J, Walker CD. Stress and selective attention: The interplay of mood, cortisol levels, and emotional information processing. Psychophysiology 2002; 39 (6) : 723-32.","journal-title":"Psychophysiology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1037\/a0013281","volume":"122","author":"Starcke K.","year":"2008","unstructured":"Starcke K, Wolf OT, Markowitsch HJ, Brand M. Anticipatory stress influences decision making under explicit risk conditions. Behav Neurosci 2008; 122 (6) : 1352-60.","journal-title":"Behav. Neurosci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"38","DOI":"10.18533\/ijbsr.v6i3.936","volume":"6","author":"Atsan N.","year":"2016","unstructured":"Atsan N. Decision-making under stress and its implications for managerial decision-making: A review of literature. International Journal of Business and Social Research 2016; 6 (3) : 38-47.","journal-title":"International Journal of Business and Social Research."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Nelson DL, Simmons BL. Health psychology and work stress: A more positive approach 2003.","DOI":"10.1037\/10474-005"},{"key":"ref20","first-page":"459","volume":"18","author":"Yerkes R.M.","year":"1908","unstructured":"Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit formation. J Comp Neurol 1908; 18 (5) : 459-82.","journal-title":"J. Comp. Neurol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/10615806.2010.548088","volume":"25","author":"Mark G.","year":"2012","unstructured":"Mark G, Smith AP. Effects of occupational stress, job characteristics, coping, and attributional style on the mental health and job satisfaction of university employees. Anxiety Stress Coping 2012; 25 (1) : 63-78.","journal-title":"Anxiety Stress Coping"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.biopsycho.2010.05.002","volume":"86","author":"Zanstra Y.J.","year":"2011","unstructured":"Zanstra YJ, Johnston DW. Cardiovascular reactivity in real life settings: measurement, mechanisms and meaning. Biol Psychol 2011; 86 (2) : 98-105.","journal-title":"Biol. Psychol."},{"key":"ref23","unstructured":"Cunha JPS. pHealth and wearable technologies: A permanent challenge. In: Blobel B, Pharow P, Sousa F, editors. pHealth 2012- Proceedings of the 9th Conference on Wearable Micro and Nano Technologies for Personalized Health 177. Porto, Portugal: IOS Press; 2012. p. 185-95."},{"key":"ref24","first-page":"22","volume":"2010","author":"Cunha J.P.S.","year":"2010","unstructured":"Cunha JPS, Cunha B, Pereira AS, Xavier W, Ferreira N, Meireles L. VitalJacket: A wearable wireless vital signs monitor for patients\u2019 mobility in cardiology and sports. 4th. Int Conf Pervasive Comput Technol Healthc 2010; 2010 : 22-5.","journal-title":"Int. Conf. Pervasive Comput. Technol. Healthc."},{"key":"ref25","unstructured":"Biodevices Certifications 2017. Available from: http:\/\/www.vitaljacket.com"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.2044-8260.1992.tb00997.x","volume":"31","author":"Marteau T.M.","year":"1992","unstructured":"Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992; 31 (Pt 3) : 301-6.","journal-title":"Br. J. Clin. Psychol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1093\/occmed\/kqs140","volume":"62","author":"Lesage F.X.","year":"2012","unstructured":"Lesage FX, Berjot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occup Med (Lond) 2012; 62 (8) : 600-5.","journal-title":"Occup. Med. (Lond.)"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3389\/fnhum.2016.00200","volume":"10","author":"Ribeiro M.J.","year":"2016","unstructured":"Ribeiro MJ, Paiva JS, Castelo-Branco M. Spontaneous fluctuations in sensory processing predict within-subject reaction time variability. Front Hum Neurosci 2016; 10 : 200.","journal-title":"Front. Hum. Neurosci."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1159\/000119004","volume":"28","author":"Kirschbaum C.","year":"1993","unstructured":"Kirschbaum C, Pirke K-M, Hellhammer DH. The \u2018Trier Social Stress Test\u2019-A tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 1993; 28 (1-2) : 76-81.","journal-title":"Neuropsychobiology"},{"key":"ref30","unstructured":"Pallant J. SPSS survival manual 2013."},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Georgieva K, Georgieva O, Georgieva P, Ribeiro MJ, Paiva JS. Regression approach for automatic detection of attention lapses. In: Intelligent Systems (IS), 2016 IEEE 8th International Conference; 2016. 2016.","DOI":"10.1109\/IS.2016.7737447"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1109\/TBME.1985.325532","volume":"32","author":"Pan J.","year":"1985","unstructured":"Pan J, Tompkins WJ. A real-time QRS detection algorithm. IEEE Trans Biomed Eng 1985; 32 (3) : 230-6.","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref33","unstructured":"Clifford GD, Azuaje F, McSharry P. Advanced methods and tools for ECG data analysis 2006."},{"key":"ref34","unstructured":"Task Force of the European Society of Cardiology Heart rate variability, standards of measurement, physiological interpretation, and clinical use circulation 1996."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/BF00648343","volume":"39","author":"Lomb N.R.","year":"1976","unstructured":"Lomb NR. Least-squares frequency analysis of unequally spaced data. Astrophys Space Sci 1976; 39 (2) : 447-62.","journal-title":"Astrophys. Space Sci."},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Schaaff K, Adam MT, Eds. Measuring emotional arousal for online applications: Evaluation of ultra-short term heart rate variability measures. 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction 2013.","DOI":"10.1109\/ACII.2013.66"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1002\/smi.2533","volume":"31","author":"Olver J.S.","year":"2015","unstructured":"Olver JS, Pinney M, Maruff P, Norman TR. Impairments of spatial working memory and attention following acute psychosocial stress. Stress Health 2015; 31 (2) : 115-23.","journal-title":"Stress Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"78","DOI":"10.5688\/aj710478","volume":"71","author":"McCorry L.K.","year":"2007","unstructured":"McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ 2007; 71 (4) : 78.","journal-title":"Am. J. Pharm. Educ."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.biopsycho.2008.11.005","volume":"80","author":"Schubert C.","year":"2009","unstructured":"Schubert C, Lambertz M, Nelesen RA, Bardwell W, Choi J-B, Dimsdale JE. Effects of stress on heart rate complexity-A comparison between short-term and chronic stress. Biol Psychol 2009; 80 (3) : 325-32.","journal-title":"Biol. Psychol."},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Taelman J, Vandeput S, Spaepen A, Van Huffel S. Influence of mental stress on heart rate and heart rate variability 4th European conference of the international federation for medical and biological engineering Springer; 2009. 2009.","DOI":"10.1007\/978-3-540-89208-3_324"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.2174\/1875934301508010032","volume":"8","author":"Trimmel M.","year":"2015","unstructured":"Trimmel M. Relationship of Heart Rate Variability (HRV) parameters including pNNxx with the subjective experience of stress, depression, well-being, and every-day trait moods (TRIM-T): A pilot study. Ergonomics Open J 2015; 8 (1)","journal-title":"Ergonomics Open J."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"515","DOI":"10.2466\/pms.2000.91.2.515","volume":"91","author":"Delaney J.P.","year":"2000","unstructured":"Delaney JP, Brodie DA. Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Percept Mot Skills 2000; 91 (2) : 515-24.","journal-title":"Percept. Mot. Skills"},{"key":"ref43","first-page":"59","volume":"15","author":"Kaur S.","year":"2013","unstructured":"Kaur S, Bhalla P, Bajaj S, Sanyal S, Babbar R. Effect of physical and mental stress on heart rate variability in type-A and type-B personalities. Indian Journal of Applied Basic Medical Sciences 2013; 15 (20) : 59-70.","journal-title":"Indian Journal of Applied Basic Medical Sciences."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"E1080","DOI":"10.3390\/ijerph15061080","volume":"15","author":"Rodrigues S.","year":"2018","unstructured":"Rodrigues S, Paiva JS, Dias D, Aleixo M, Filipe RM, Cunha JPS. Cognitive impact and psychophysiological effects of stress using a biomonitoring platform. Int J Environ Res Public Health 2018; 15 (6) : E1080.","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/j.1467-6494.2005.00377.x","volume":"74","author":"Robinson M.D.","year":"2006","unstructured":"Robinson MD, Wilkowski BM, Meier BP. Unstable in more ways than one: Reaction time variability and the neuroticism\/distress relationship. J Pers 2006; 74 (2) : 311-43.","journal-title":"J. Pers."}],"container-title":["Clinical Practice &amp; Epidemiology in Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V14\/CPEMH-14-250\/CPEMH-14-250.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V14\/CPEMH-14-250\/CPEMH-14-250.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V14\/CPEMH-14-250\/CPEMH-14-250.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T18:00:40Z","timestamp":1572544840000},"score":1,"resource":{"primary":{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/VOLUME\/14\/PAGE\/250\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,31]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,10,31]]}},"alternative-id":["CPEMH-14-250"],"URL":"https:\/\/doi.org\/10.2174\/1745017901814010250","relation":{},"ISSN":["1745-0179"],"issn-type":[{"value":"1745-0179","type":"print"}],"subject":[],"published":{"date-parts":[[2018,10,31]]},"assertion":[{"value":"Peer Reviewed","order":0,"name":"review_status","label":"Review Status","group":{"name":"peer_review_details","label":"Peer Review Details"}},{"value":"Single blind","order":1,"name":"review_process","label":"Review Process","group":{"name":"peer_review_details","label":"Peer Review Details"}},{"value":"Checked with iThenticate","order":0,"name":"screening_status","label":"Screening Status","group":{"name":"plagiarism_screening","label":"Plagiarism Screening"}},{"value":"2018-7-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-1","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-8","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}