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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Pública, Florianópolis, 2017. Os profissionais da atenção básica, devido à natureza do seu trabalho e dos atuais aspectos organizacionais do contexto brasileiro, podem experimentar estresse organizacional. Uma Prática Integrativa e Complementar que crescente evidência científica têm indicado como capaz de reduzir o estresse organizacional é a meditação mindfulness. Apesar de ter sua eficácia demonstrada por pesquisas, não há ainda evidências sobre a viabilidade de programas de mindfulness para o contexto específico da atenção básica do Sistema Único de Saúde. O presente trabalho, através de uma matriz avaliativa, avalia se um programa de meditação mindfulness é viável no contexto da atenção básica, bem como classifica o programa e seus componentes em níveis de viabilidade. Os resultados indicam que a atenção básica já dispõe do espaço e materiais necessários para a realização do programa. Além disso, o Sistema Único de Saúde favorece ações voltadas a saúde do trabalhador, o que é um facilitador para a sua implementação. Uma barreira crítica pode ser a extensão do programa em relação ao número de semanas e horas, além da dificuldade em encontrar instrutores de mindfulness com a formação completa recomendada. Os resultados indicam também que há demanda pela intervenção, já que os profissionais da atenção básica percebem a si e aos colegas como estressados. Por fim, os profissionais aceitaram o programa por considerar-lhe útil para a redução do estresse e o recomendariam para colegas de trabalho. O programa de meditação mindfulness foi julgado como viável para o contexto da atenção básica. Abstract : Primary care professionals, due to the nature of their work and the actual organizational aspects of brazilian health system, can experience organizational stress. An integrative and complementary therapy which a growing body of scientific evidence is showing as capable of reducing stress is mindfulness meditation. Although having the efficacy demonstrated by research, there is still no evidence about the feasibility of mindfulness based programs for the specific context of the primary care of the Sistema Único de Saúde. This paper aims, through the use of an evaluation matrix, to evaluate the feasibility of a mindfulness meditation program in the context of primary care, as well as to assess the feasibility levels of different components of the program and of the program itself. The results show that que primary care context already disposes from the necessary material and physical space to execute the program. The Sistema Único de Saúde also favors action aiming to promote workers? health, which is a facilitator for implementation. A critical barrier can be the program extension in number of weeks and hours, besides the difficulty in finding professionals with the complete formation required. The data shows that there is demand for the intervention, since the primary care professionals feel themselves and their colleagues as being stressed. Although retention rates could be higher, the professionals accepted the program as useful to reduce stress and would recommend it for other primary care professionals. The mindfulness based program was evaluated as feasible in the context of brazilian primary care.

In Australia, the Strengths and Difficulties Questionnaire (SDQ) has been implemented in several national studies, including the Longitudinal Study of Australian Children (LSAC). However, three previous state-level validations indicated problems with instrument dimensionality, warranting further research. To address this gap, the current study employed exploratory graph analysis to investigate dimensionality of the caregiver-completed SDQ version 4 to 10 years in a nationally representative sample of Australian children. Data were from a dual cohort cross-sequential study (LSAC) that included more than 20,000 responses. Gaussian graphical models were estimated in each study wave and exploratory graph analysis applied. Structural consistency, item stability and network loadings were evaluated. The findings provided mixed support for the original SDQ five-factor structure. The Peer Problem scale displayed low structural consistency since items clustered with the Emotional Symptoms and Prosocial behavior, generating four-dimensional structures. Implications for future use of the SDQ version 4 to 10 years in Australia are provided. Refereed/Peer-reviewed

Introduction In Australia, health-related quality of life (HRQoL) instruments have been adopted in national population surveys to inform policy decisions that affect the health of Aboriginal and Torres Strait Islanders. However, Western-developed HRQoL instruments should not be assumed to capture Indigenous conceptualization of health and well-being. In our study, following recommendations for cultural adaptation, an Indigenous Reference Group indicated the EQ-5D-5L as a potentially valid instrument to measure aspects of HRQoL and endorsed further psychometric evaluation. Thus, this study aimed to investigate the construct validity and reliability of the EQ-5D-5L in an Aboriginal Australian population. Methods The EQ-5D-5L was applied in a sample of 1012 Aboriginal adults. Dimensionality was evaluated using Exploratory Graph Analysis. The Partial Credit Model was employed to evaluate item performance and adequacy of response categories. Area under the receiver operating characteristic curve (AUROC) was used to investigate discriminant validity regarding chronic pain, general health and experiences of discrimination. Results The EQ-5D-5L comprised two dimensions, Physiological and Psychological, and reliability was adequate. Performance at an item level was excellent and the EQ-5D-5L individual items displayed good discriminant validity. Conclusions The EQ-5D-5L is a suitable instrument to measure five specific aspects (Mobility, Self-Care, Usual activities, Pain/Discomfort, Anxiety/Depression) of Aboriginal and Torres Strait Islander HRQoL. A future research agenda comprises the investigation of other domains of Aboriginal and Torres Strait Islander HRQoL and potential expansions to the instrument.

Refereed/Peer-reviewed In Australia, one of the most frequently used measures for assessing social and emotional well-being (SEWB) of Aboriginal and/or Torres Strait Islander children is the Strengths and Difficulties Questionnaire (SDQ). Previous studies on state-level validations have indicated the problems associated with the original five-factor SDQ structure, especially in the dimension of Peer Problems. The aim of this study was to use a novel psychometric methodology, namely Exploratory Graph Analysis (EGA), to evaluate the dimensionality of caregiver-informant SDQ version 4–10 years at a national level in Australia. Data for this study were retrospectively collected from two independent longitudinal studies: the Longitudinal Study of Indigenous Children (LSIC) and South Australian Aboriginal Birth Cohort (SAABC). The caregiver-informed SDQ version 4–10 years was applied across several study waves, including more than 4,000 responses. To conduct EGA, Gaussian graphical models (GGMs) were estimated using the Least Absolute Shrinkage and Selection Operator. About 2,500 bootstrap samples were also employed to investigate dimensions and item stability. The findings indicated robust evidence against the construct validity of the original five-factor SDQ structure. Future studies should conduct a direct external validation of the findings with Aboriginal and/or Torres Strait Islander parents/carers and community groups to develop the guidelines for future use of the instrument among Aboriginal and/or Torres Strait Islander children in Australia.