Background: The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual’s resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective: This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods: In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes.
MULTIFILE
Attitudes of dental students regarding the provision of treatment tend to be dentist-centered; however, facilitating mixed student group formation could change such perceptions. The aim of this study was to investigate the perceived scope of practice of dental and dental hygiene students and whether their perceptions of task distribution between dentists and dental hygienists would change following an educational intervention consisting of feedback, intergroup comparison, and competition between mixed-group teams. The study employed a pretest-posttest single group design. Third-year dental students and second-year dental hygiene students at a university in The Netherlands were randomly assigned to intraprofessional teams (four or five members) and received team-based performance feedback and comparison. The intervention was finalized with an award ceremony for the best intraprofessional team. Before and after the intervention, students completed a questionnaire measuring their perceived distribution of ten tasks between dentists and dental hygienists. A total of 38 dental students and 32 dental hygiene students participated in the intervention-all 70 of those eligible. Questionnaires were completed by a total 88.4% (n=61) of the participants: 34 dental (89.5%) and 27 dental hygiene students (84.4%). Dental and dental hygiene students had similar perceptions regarding teeth cleaning (prophylaxis) (p=0.372, p=0.404) and, after the intervention, preventive tasks (p=0.078). Following the intervention, dental students considered four out of ten tasks as less dentist-centered: radiograph for periodontal diagnosis (p=0.003), local anesthesia (p=0.037), teeth cleaning (p=0.037), and periodontal treatment (p=0.045). Dental hygiene students perceived one task as being less dentist-centered after the intervention: radiograph for cariologic diagnosis (p=0.041). This study found that these dental and dental hygiene students had different opinions regarding the scope of practice for dentistry and dental hygiene. The number of redistributed tasks after the intervention was especially substantial among the dental students, although the amount of change per task was minimal. Half of all tasks were perceived as less dentist-centered as a result of the intervention.
Background: Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples’ oral health, in order to provide recommendations for practice, policy, and research. Methods: A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to ‘oral health assessments’, ‘non-dental healthcare professionals’ and ‘older people (60+)’ were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using “The Consensus-based Standards for the selection of health Measurement Instruments” (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). Results: Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. Conclusion: Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.
