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- Unseen strains: The critical role of psychosocial risks, mental health and violence in nurses’ musculoskeletal disordersPublication . Baylina, Pilar; Santos, Paula Machado; Barros, Carla; BAYLINA MACHADO, PILARWork-related Musculoskeletal disorders (WRMSDs) are highly prevalent among nurses, not only due to the physical demands but also because of significant psychosocial stressors and mental health challenges inherent in healthcare environments. This study investigates the relationship between psychosocial factors, mental health, and workplace violence with the occurrence of WRMSDs in nurses. A total of 266 nurses from various healthcare units participated in this study. Three validated questionnaires were used: the Health and Work Survey (INSAT) to assess psychosocial factors and musculoskeletal disorders; The Violence at Work Scale to measure exposure to violence factors; and the DASS-21 scale to evaluate mental health dimensions, depression, anxiety, and stress. Data analysis was conducted using descriptive and inferential statistics to determine the associations between the investigated factors and WRMSDs. This study analyzed the complex relationships that exist between three clusters of characteristics – psychosocial risk factors, mental health, particularly anxiety, and workplace violence – and workrelated musculoskeletal diseases (WRMSDs) in Portuguese nurses. In sum, inadequate guidance, low decision latitude, skill-development barriers, anxiety, and violence form the principal drivers of WRMSDs in this workforce. This study's results highlight the importance of addressing psychosocial factors, mental health, and workplace violence to reduce the incidence of WRMSDs among nurses. Interventions focused on improving working conditions and promoting mental health may be effective in preventing WRMSDs among nurses.
- Psychosocial risk factors and burnout among teachers: Can emotional intelligence make a difference?Publication . Barros, Carla; Fernandes, Carina; Baylina, Pilar; BAYLINA MACHADO, PILARTeaching is a complex profession that demands simultaneous cognitive and emotional efforts. The present study aims to determine whether teachers’ emotional intelligence moderates the relationship between psychosocial risk factors and burnout. A cross-sectional online survey was conducted among 215 secondary school teachers. Measurement instruments included the Burnout Assessment Tool (BAT-23) to assess burnout dimensions; the Health and Work Survey (INSAT) to evaluate psychosocial risk factors; and the Wong and Law Emotional Intelligence Scale (WLEIS-P) to assess emotional intelligence. A mediation/moderation analysis using the PROCESS macro was conducted to examine whether emotional intelligence mediates/moderates the relationship between psychosocial risk factors and burnout among teachers. The results show that psychosocial risk was a significant positive predictor of burnout (B = 0.313, p = 0.001), indicating that higher perceived risk was associated with higher burnout symptoms. Emotional intelligence did not significantly predict burnout on its own (B = 0.176, p = 0.364), and the interaction term (psychosocial risk × emotional intelligence) was not significant (B = 0.000, p = 0.995), suggesting that emotional intelligence does not moderate the relationship between psychosocial risks and burnout. These findings underscore a more holistic approach to address burnout, centered in intervention strategies that include a deeper analysis of organizational context determinants.
- Psychometric validation of the European Portuguese version of The Fatigue and Altered Cognition Scale (FACs)Publication . Fernandes, Carina; Baylina, Pilar; Barbosa, Fernando; Barros, Carla; BAYLINA MACHADO, PILARFatigue and “brain fog” are symptoms that may arise from lifestyle factors and various clinical conditions. Despite their significant impact on daily functioning, there is a lack of psychometrically robust instruments to measure their co-occurrence. The Fatigue and Altered Cognition Scale (FACs) was developed to address this gap, allowing the assessment of central fatigue and cognitive complaints commonly referred to as brain fog. In the present study, we translated, culturally adapted, and validated the FACs for European Portuguese. A sample of 591 Portuguese-speaking adults completed the Portuguese version of the FACs, along with the Burnout Assessment Tool (BAT) and the Depression, Anxiety, and Stress Scales (DASS). Confirmatory Factor Analysis tested the factorial structure, and internal consistency and convergent validity were also evaluated. A bifactor model demonstrated the presence of a general factor underlying all items. Internal consistency was excellent, and the FACs exhibited strong positive correlations with both the BAT and the DASS. Moreover, the FACs demonstrated strong criterion-related validity through its significant and robust associations with burnout, depression, anxiety, and stress. Our findings establish the FACs as a valid, reliable, and efficient instrument for both clinical and research applications within European Portuguese contexts.
- Burnout among healthcare workers: Insights for holistic well-beingPublication . Fernandes, Carina; Barros, Carla; Baylina, Pilar; BAYLINA MACHADO, PILARIn the healthcare sector, burnout has become a critical concern due to high job demands and emotional strain. The main objective of the study is to examine the predictive role of psychosocial work-related risks in the development of burnout. A cross-sectional study was conducted, using a snowball recruitment method, from May to September 2025, among 154 healthcare workers. Data were collected using the psychosocial risk factors scale (INSAT_ERPS) and the Burnout Assessment Tool (BAT) and analyzed with descriptive and inferential statistics to analyze the predictive role of the psychosocial risk on burnout dimensions. Psychosocial risk factors are consistently linked to the development of burnout symptoms. For exhaustion, the predictors included Working Hours (β = 0.312, p < 0.001), Social Work Relations (β = 0.196, p = 0.026), and Emotional Demands (β = 0.295, p = 0.002). For mental distance, the predictors included Work Intensity (β = −0.193, p = 0.049), Emotional Demands (β = 0.294, p = 0.004), and Work Values (β = 0.348, p = 0.003). For cognitive impairment, Work Values (β = 0.240, p = 0.042) and for emotional impairment, Employment Relations (β = 0.182, p = 0.038) emerged only one significant positive predictor. Findings underscore a crucial understanding: the development of burnout is not solely determined by the workload intensity, or the number of hours worked, the quality of working life and the dynamics within the workplace play pivotal roles in predicting burnout. A multidomain evaluation aligns with a holistic well-being approach to well-being by emphasizing that enhancing healthcare workers’ health demands systemic interventions addressing psychosocial work environment.
- The impact of a rectal spacer in VMAT Dosimetry in the treatment of Prostate CancerPublication . Oliveira, Susana; Fernandes, Ruben; Baylina, Pilar; Santos, João; Vieira, Guy; Faria, Isabel; Pereira, Norberto; Fernandes, Rúben; BAYLINA MACHADO, PILAR; Sousa Pinho Faria, Isabel MariaAlthough the dosimetric advantages of rectal spacers in prostate cancer radiotherapy have been demonstrated in selected clinical trials, real-world data from routine clinical practice remain limited—particularly within the Portuguese healthcare system. This study offers a detailed dosimetric comparison of Volumetric Modulated Arc Therapy (VMAT), with and without rectal spacer use, in a real-world patient cohort, aiming to assess the clinical relevance of spacer insertion under standard treatment protocols. A retrospective dosimetric evaluation was performed on 80 prostate cancer patients treated at a radiotherapy centre in southern Portugal. Patients were equally divided into two matched groups (n = 40): one receiving VMAT alone, the other receiving VMAT with hydrogel rectal spacer placement. Dose-volume histograms (DVHs) were analysed for the planning target volume (PTV) and key organs at risk (OARs). Standard dosimetric metrics, such as V50–V75 for the rectum and bladder, V50 for femoral heads, and mean dose for the penile bulb, were assessed. PTV coverage was evaluated using conformity and homogeneity indices. Spacer use significantly decreased rectal dose exposure across all evaluated parameters without compromising PTV coverage or increasing dose to other OARs. These findings support routine rectal spacer applications to enhance treatment safety and patient outcomes.
- Impact of work and personal life conciliation problems on healthcare workersPublication . Fonte, Carla; Barros, Carla; Baylina, Pilar; Alves, Sónia; Moreira, Paulo; BAYLINA MACHADO, PILARWork life balance, a significant issue in the healthcare sector, recognizes that individuals are engaged in several tasks in their private and professional lives. Literature highlights the harmful consequences of conflicts between personal and professional life for organizations and workers. This study investigates the prevalence of work life balance problems and presence of psychosocial work factors and analyzes their impact on health complaints in the Portuguese healthcare sector. A cross-sectional study of 640 healthcare professionals was conducted using two data collection instruments: INSAT (Inquérito Saúde e Trabalho), a health and work survey to assess psychosocial work factors, and the Portuguese version of the Nottingham Health Profile that evaluates the subjective physical, emotional, and social aspects of health. The data show that healthcare professionals have a very high prevalence of work life balance problems and are exposed to several psychosocial risk factors including high demands and work intensity, working hours, emotional demands, and work characteristics. These experiences are related to professionals’ health revealing a state of emotional vulnerability. Thus, Portuguese health organizations should formulate appropriate workplace policy to reduce work life conflict and enable employees to be more effective in their work and other roles.
- The implementation of HFMEA in a primary care emergency service of the portuguese national health systemPublication . Macedo, José Mário; Sá, Sara; Gestoso, Álvaro; Ramalho, Susana; Luís, Carla; Martins-Mendes, Daniela; Pereira, Ana Cláudia; Fernandes, Rúben; Baylina, Pilar; BAYLINA MACHADO, PILAROne of the main priorities for healthcare institutions is to provide better and more advanced services that contribute to prolonging the lives of those who seek their care, as well as improving their quality of life as long as it lasts. Both their patients and the professionals who work in those institutions need to feel protected against adverse effects that may affect them physically, mentally, or socially. As such, both at national and international levels, healthcare governing bodies have made decisions and implemented measures aimed at reducing the risk of adverse effects for the patients who use their services. The main objective of this work was to develop and implement a risk management system based on HFMEA in a basic emergency service (primary care), to promote patient safety and the safety of healthcare professionals. A prospective, explanatory, and descriptive case study was applied to a basic emergency service, using ISO 31000 – risk management in organisations, and the healthcare failure mode and effects analyses (HFMEA) support tool. There were identified 57 possible failures associated with 88 different effects, with risk magnitudes classified as severe (1 cases), very severe (18 cases), and intolerable (38 cases). Failures whose effects impact patients were mentioned 2,6 times more than those primarily affecting professionals. The study allowed the identification of different failures in some of its work processes, for which corrective measures were determined to be carried out by the team and the governing entities of the service, to be implemented as soon as possible, ensuring greater safety in its services.
- O sangue dos inocentes pelos olhos dos ímpios: entre fobias e cegueiras ideológicasPublication . Rodrigues, Ricardo; CARDOSO RODRIGUES, RICARDO ALEXANDREDesde quando abandonamos os rostos e as suas lágrimas? Desde quando vibramos com a morte, com a dor e o sofrimento alheios? Quantos e quantas deixamos prostrados, deixamos para trás? Haverá corpos, identidades e famílias mais dignos; culturas e religiões, per se, sacralizáveis, condenáveis, demonizáveis ou impuras; “enfermos” menos merecedores de cuidados? Desde quando os nossos “eus” se tornaram pontos de referência para os “eus” dos outros? Onde moram as nossas ancestralidades e as nossas descendências nas narrativas e nos discursos? Desde quando nos concebemos produtos acabados? Desde quando deixamos de reconhecer o estrangeiro que habita em nós? Que partes do outro entendemos por estranhas? Quanto de estranho consideramos relevante para a sua desumanização? E nesse espaço de não ser, quanto valeria a sua dor e o seu sofrimento; como significar as suas lágrimas, perdas e lutos; qual a medida certa; como mensurar; qual a fórmula exata? Seria bastante uma simples perceção; uma singela perceção forjada numa singela manchete; de qualquer agência ou veículo? Uma perceção pelo valor de uma vida?Desde quando abandonamos os rostos e as suas lágrimas? Desde quando vibramos com a morte, com a dor e o sofrimento alheios? Quantos e quantas deixamos prostrados, deixamos para trás? Haverá corpos, identidades e famílias mais dignos; culturas e religiões, per se, sacralizáveis, condenáveis, demonizáveis ou impuras; “enfermos” menos merecedores de cuidados? Desde quando os nossos “eus” se tornaram pontos de referência para os “eus” dos outros? Onde moram as nossas ancestralidades e as nossas descendências nas narrativas e nos discursos? Desde quando nos concebemos produtos acabados? Desde quando deixamos de reconhecer o estrangeiro que habita em nós? Que partes do outro entendemos por estranhas? Quanto de estranho consideramos relevante para a sua desumanização? E nesse espaço de não ser, quanto valeria a sua dor e o seu sofrimento; como significar as suas lágrimas, perdas e lutos; qual a medida certa; como mensurar; qual a fórmula exata? Seria bastante uma simples perceção; uma singela perceção forjada numa singela manchete; de qualquer agência ou veículo? Uma perceção pelo valor de uma vida?
- Translation and cultural adaptation of the HFMEA into European PortuguesePublication . Santos, Paula Machado; Morais, Carminda; Baylina, Pilar; BAYLINA MACHADO, PILARHealth organizations are faced with daily challenges, requiring them to provide a quality service, ensuring effectiveness and efficiency. Risk management is one of the conditioning factors to achieve this purpose, ensuring preventive actions for all processes, promoting the identification of risk to the mitigation of its consequences for the patient, professionals, or organization. Patient safety is a priority and healthcare organizations should be concerned with the implementation of methodologies and tools to promote risk management, such as Healthcare Failure Mode and Effects Analysis (HFMEA). HFMEA has a high potential for risk management in healthcare organizations, with a proactive, prospective, and continuous approach to improvement. Translation and adaptation of the HFMEA instrument into European Portuguese. A methodological study was carried out based on the proposal presented by Beaton and followed the recommendations of the International Test Commission and World Health Organization. The HFMEA 2021 was linguistically translated and culturally adapted to the new context ensuring reliability, content validity was assured by a group of experts, which ensured semantic, idiomatic, experimental, and conceptual equivalence between the original instrument and the translation. HFMEA 2021 was successfully translated and adapted to European Portuguese, allowing its application.
- A retrospective study in tumour characteristics and clinical outcomes of overweight and obese women with breast cancerPublication . Luís, Carla; Dias, João; Firmino‑Machado, João; Fernandes, Rute; Pereira, Deolinda; Baylina, Pilar; Fernandes, Rúben; Soares, Raquel; BAYLINA MACHADO, PILAR; Fernandes, RúbenObesity and breast cancer are two major pathologies closely associated with increasing incidence and mortality rates, especially amongst women. The association between both diseases have been thoroughly discussed but much is still to uncover. The aim of this study is to analyse tumour characteristics and clinical outcomes of overweight and obese women to disclosure potential associations and better understand the impact of obesity in breast cancer. Clinicopathological information of 2246 women were extracted from the institutional database of comprehensive cancer centre in Portugal diagnosed between 2012 and 2016. Women were stratifed according to body mass index as normal, overweight, and obese. Patients’ demographic information and tumour features (age, family history, topographic localization, laterality, histological type, and receptor status) were taken as independent variables and overall survival, tumour stage, diferentiation grade and bilaterality were considered clinical outcomes. The main results reveal that overweight and obesity are predominantly associated with worse outcomes in breast cancer patients. Obese patients present larger (p-value: 0.002; OR 1.422; 95% CI 1.134–1.783) and more poorly diferentiated tumours (p-value: 0.002; OR 1.480; 95% CI 1.154–1.898) and tend to have lower overall survival although without statistical signifcance (p-value: 0.117; OR 1.309; 95% CI 0.934–1.833). Overweighted women are more likely to have bilateral breast cancer (p-value: 0.017; OR 3.076; 95% CI 1.225–7.722) than obese women. The results also reveal that overweight women present less distant metastasis (p-value: 0.024; OR 0.525; 95%CI 0.299–0.920). Topographic localization and laterality did not achieve statistical signifcance.