{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:13:04Z","timestamp":1785420784409,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["456123789"],"award-info":[{"award-number":["456123789"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"award":["456123789"],"award-info":[{"award-number":["456123789"]}],"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Brazilian Council for Scientific and Technological Development","award":["18\/2021"],"award-info":[{"award-number":["18\/2021"]}]},{"name":"Brazilian Council for Scientific and Technological Development","award":["408.322\/2021-7"],"award-info":[{"award-number":["408.322\/2021-7"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>This study investigates the impact of different types of personal protective equipment (PPE), specifically Powered Air-Purifying Respirators (PAPRs) and traditional N95 masks with face shields, on the physiological stress responses of healthcare workers (HWs) during the COVID-19 pandemic. Utilizing an interventional randomized crossover trial design, the research encompasses a simulation phase with ten participants followed by field testing involving thirty frontline healthcare professionals in a tertiary-care hospital setting. Heart rate (HR) and movement data were collected through smartwatches, while trained observers recorded the duration and nature of various activities undertaken during simulations. Data analysis employed statistical techniques, including Principal Component Analysis (PCA) and t-Distributed Stochastic Neighbor Embedding (t-SNE), to explore potential correlations between PPE type, HR, and movement. Clustering validation measures such as the Calinski\u2013Harabasz, Davies\u2013Bouldin, and Silhouette scores were applied to evaluate the difference between each type of PPE. The results indicated no significant differentiation in HR responses between the two PPE types. However, because HR may lack the sensitivity to fully capture variations in cognitive load or stress, these findings should be interpreted as an exploratory baseline. Additionally, no clear distinctions were observed regarding individual user responses or the activities performed, even when considering movement data. Although the findings imply non-inferiority of the examined PPE, future research including heart rate variability as a more comprehensive indicator of stress would be informative. This research contributes valuable insights into PPE selection and its implications for healthcare worker performance and well-being in high-stress environments, ultimately aiming to inform guidelines and training programs to enhance healthcare delivery during infectious disease outbreaks.<\/jats:p>","DOI":"10.3390\/s26113531","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:37:26Z","timestamp":1780454246000},"page":"3531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using Heart Rate to Measure Stress in Healthcare Workers Wearing PAPRs and N95 Masks: Insights from a Randomized Trial"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2663-5464","authenticated-orcid":false,"given":"Rodrigo M. A.","family":"Almeida","sequence":"first","affiliation":[{"name":"Institute of Systems Engineering and Information Technology, Federal University of Itajub\u00e1\u2014UNIFEI, Itajub\u00e1 37500-903, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5990-851X","authenticated-orcid":false,"given":"Rafael Rocha","family":"Maciel","sequence":"additional","affiliation":[{"name":"Institute of Systems Engineering and Information Technology, Federal University of Itajub\u00e1\u2014UNIFEI, Itajub\u00e1 37500-903, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1361-2754","authenticated-orcid":false,"given":"Carlos Henrique Val\u00e9rio","family":"Moraes","sequence":"additional","affiliation":[{"name":"Institute of Systems Engineering and Information Technology, Federal University of Itajub\u00e1\u2014UNIFEI, Itajub\u00e1 37500-903, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0893-7255","authenticated-orcid":false,"given":"Caroline Lopes","family":"Ciofi-Silva","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Campinas\u2014UNICAMP, Campinas 13083-887, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8340-5334","authenticated-orcid":false,"given":"Naila A.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"S\u00e3o Leopoldo Mandic Medical School, Araras 13600-001, SP, Brazil"},{"name":"S\u00e3o Leopoldo Mandic Medical School, Limeira 13482-890, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia M.","family":"Mainardi","sequence":"additional","affiliation":[{"name":"School of Nursing, University of S\u00e3o Paulo\u2014USP, S\u00e3o Paulo 05403-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Cordeiro","sequence":"additional","affiliation":[{"name":"School of Nursing, University of S\u00e3o Paulo\u2014USP, S\u00e3o Paulo 05403-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Sara Shafferman","family":"Levin","sequence":"additional","affiliation":[{"name":"School of Nursing, University of S\u00e3o Paulo\u2014USP, S\u00e3o Paulo 05403-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5200-7322","authenticated-orcid":false,"given":"Amy I.","family":"Price","sequence":"additional","affiliation":[{"name":"Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Ling","family":"Lin","sequence":"additional","affiliation":[{"name":"World Health Organization\u2014WHO, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1912-7293","authenticated-orcid":false,"given":"Maria Clara","family":"Padoveze","sequence":"additional","affiliation":[{"name":"School of Nursing, University of S\u00e3o Paulo\u2014USP, S\u00e3o Paulo 05403-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/0022-3999(86)90080-2","article-title":"Heart rate as an indicator of stress in suegeons and anaesthetists","volume":"30","author":"Payne","year":"1986","journal-title":"J. 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