Caminhos em Saúde Mental / Paths in Mental Health

Desenvolvido entre março e dezembro de 2020, pelo Instituto Cactus em parceria com o Instituto Veredas, o levantamento Caminhos em Saúde Mental oferece um complexo entendimento a respeito do campo da saúde mental, incluindo seu histórico e estruturas no Brasil. Para isso, consideramos os consensos produzidos por organismos internacionais e a própria experiência brasileira ­ que por décadas serviu de modelo para a construção de estratégias comunitárias de cuidado no mundo. Lançado em junho de 2021, o relatório inédito sobre os caminhos de atuação em saúde mental no Brasil teve como objetivo promover um olhar mais amplo e, ao mesmo tempo, aprofundado sobre o tema, com as principais abordagens e desafios para a incidência no campo no país, olhando especialmente para adolescentes e mulheres. As discussões sobre saúde mental estão muito presentes atualmente, em especial no contexto da pandemia de COVID-19. É muito comum que o assunto seja abordado ao se pensar nas dificuldades que as pessoas têm para lidar com suas emoções e sentimentos, por exemplo quando se sentem tristes ou ansiosas além do comum, comprometendo as atividades da vida cotidiana por um período prolongado. Mas afinal, o que é saúde mental? Encontrar respostas para essa questão pode ser um grande desafio, na medida em que há diversos aspectos a considerar e uma infinidade de discursos que buscam conceituar o tema. Ainda assim, logo de partida é indispensável afirmar que a saúde mental não é apenas uma dimensão individual, dependente de fatores biológicos e psíquicos. Ela é o resultado da complexa interação entre esses aspectos individuais e as condições de vida das pessoas, que incluem as relações sociais, o ambiente de crescimento e desenvolvimento, a inclusão produtiva e o acesso a bens materiais e culturais, abrangendo também as possibilidades de participação ativa na vida comunitária. Por esse ângulo, é possível sustentar que a saúde mental, tanto pessoal quanto coletiva, depende da articulação permanente entre os indivíduos, a comunidade e a sociedade em geral, em busca da criação de condições para uma vida digna e uma realidade social mais justa para todos. Ao longo desta publicação será possível acessar, reconhecer e aprofundar estas e outras respostas, partindo também de caminhos que abordam a saúde mental como um campo de conhecimento, de práticas e de políticas públicas de cuidado.

Desarrollado entre marzo y diciembre de 2020, por el Instituto Cactus en colaboración con el Instituto Veredas, la investigación Caminos en Salud Mental ofrece una comprensión compleja del campo de la salud mental, incluyendo su historia y estructuras en Brasil. Para eso, consideramos los consensos producidos por organismos internacionales y la propia experiencia brasileña - que durante décadas sirvió de modelo para la construcción de estrategias de atención comunitaria en el mundo. Lanzado en junio de 2021, el inédito informe sobre los caminos para la acción en salud mental en Brasil tuvo como objetivo promover una mirada más amplia y, al mismo tiempo, profunda sobre el tema, con los principales abordajes y desafíos para la incidencia en el campo en el país, con especial atención a los adolescentes y a las mujeres. Los debates sobre salud mental están muy presentes hoy en día, especialmente en el contexto de la pandemia COVID-19. Es muy común que se aborde el tema cuando se piensa en las dificultades que tienen las personas para lidiar con sus emociones y sentimientos, por ejemplo, cuando se sienten tristes o ansiosas más allá de lo común, lo que compromete las actividades de la vida diaria durante un período prolongado. ¿Qué es la salud mental? Encontrar respuestas a esta pregunta puede ser un desafío, ya que hay varios aspectos que considerar y multitud de discursos que intentan conceptualizar el tema. Aun así, desde el principio es esencial afirmar que la salud mental no es sólo una dimensión individual, dependiente de factores biológicos y psicológicos. Es el resultado de la compleja interacción entre estos aspectos individuales y las condiciones de vida de las personas, que incluyen las relaciones sociales, el entorno de crecimiento y desarrollo, la inclusión productiva y el acceso a los bienes materiales y culturales, incluyendo también las posibilidades de participación activa en la vida comunitaria. Desde este ángulo, es posible sostener que la salud mental, tanto personal como colectiva, depende de la articulación permanente entre los individuos, la comunidad y la sociedad en general, en busca de la creación de condiciones para una vida digna y una realidad social más justa para todos. A lo largo de esta publicación, será posible acceder, reconocer y profundizar estas y otras respuestas, partiendo también de caminos que abordan la salud mental como campo de saberes, prácticas y políticas públicas de cuidado.

Developed between March and December 2020, by the Cactus Institute in partnership with the Veredas Institute, the survey Paths in Mental Health offers a complex understanding of the mental health field, including its history and structures in Brazil. For this, we consider the consensus produced by international organizations and the Brazilian experience itself - which for decades served as a model for the construction of community care strategies in the world. Launched in June 2021, the unprecedented report on the ways to act in mental health in Brazil aimed to promote a broader and, at the same time, deeper look at the theme, with the main approaches and challenges for the incidence in the field in the country, looking especially at teenagers and women. Discussions about mental health are very present nowadays, especially in the context of the COVID-19 pandemic. It is very common for the subject to be brought up when thinking about the difficulties people have in dealing with their emotions and feelings, for example when they feel unusually sad or anxious, compromising the activities of daily living for a prolonged period. So what is mental health? Finding answers to this question can be a great challenge, as there are several aspects to consider and a multitude of discourses that seek to conceptualize the theme. Still, from the outset, it is essential to state that mental health is not only an individual dimension, dependent on biological and psychological factors. It is the result of the complex interaction between these individual aspects and people's living conditions, which include social relations, the environment for growth and development, productive inclusion, and access to material and cultural goods, including also the possibilities of active participation in community life. From this angle, it is possible to argue that mental health, both personal and collective, depends on the permanent articulation between individuals, the community, and society in general, in search of the creation of conditions for a dignified life and a fairer social reality for all. Throughout this publication, it will be possible to access, recognize, and deepen these and other answers, starting also from paths that approach mental health as a field of knowledge, practices, and public policies of care.

Study on the surface energy of graphene by contact angle measurements.

Because of the atomic thinness of graphene, its integration into a device will always involve its interaction with at least one supporting substrate, making the surface energy of graphene critical to its real-life applications. In the current paper, the contact angle of graphene synthesized by chemical vapor deposition (CVD) was monitored temporally after synthesis using water, diiodomethane, ethylene glycol, and glycerol. The surface energy was then calculated based on the contact angle data by the Fowkes, Owens-Wendt (extended Fowkes), and Neumann models. The surface energy of fresh CVD graphene grown on a copper substrate (G/Cu) immediately after synthesis was determined to be 62.2 ± 3.1 mJ/m(2) (Fowkes), 53.0 ± 4.3 mJ/m(2) (Owens-Wendt) and 63.8 ± 2.0 mJ/m(2) (Neumann), which decreased to 45.6 ± 3.9, 37.5 ± 2.3, and 57.4 ± 2.1 mJ/m(2), respectively, after 24 h of air exposure. The ellipsometry characterization indicates that the surface energy of G/Cu is affected by airborne hydrocarbon contamination. G/Cu exhibits the highest surface energy immediately after synthesis, and the surface energy decreases after airborne contamination occurs. The root cause of intrinsically mild polarity of G/Cu surface is discussed.

Atomic-scale wear of amorphous hydrogenated carbon during intermittent contact: a combined study using experiment, simulation, and theory.

In this study, we explore the wear behavior of amplitude modulation atomic force microscopy (AM-AFM, an intermittent-contact AFM mode) tips coated with a common type of diamond-like carbon, amorphous hydrogenated carbon (a-C:H), when scanned against an ultra-nanocrystalline diamond (UNCD) sample both experimentally and through molecular dynamics (MD) simulations. Finite element analysis is utilized in a unique way to create a representative geometry of the tip to be simulated in MD. To conduct consistent and quantitative experiments, we apply a protocol that involves determining the tip-sample interaction geometry, calculating the tip-sample force and normal contact stress over the course of the wear test, and precisely quantifying the wear volume using high-resolution transmission electron microscopy imaging. The results reveal gradual wear of a-C:H with no sign of fracture or plastic deformation. The wear rate of a-C:H is consistent with a reaction-rate-based wear theory, which predicts an exponential dependence of the rate of atom removal on the average normal contact stress. From this, kinetic parameters governing the wear process are estimated. MD simulations of an a-C:H tip, whose radius is comparable to the tip radii used in experiments, making contact with a UNCD sample multiple times exhibit an atomic-level removal process. The atomistic wear events observed in the simulations are correlated with under-coordinated atomic species at the contacting surfaces.

Practical method to limit tip-sample contact stress and prevent wear in amplitude modulation atomic force microscopy.

Amplitude modulation atomic force microscopy (AM-AFM) is one of the most popular AFM modes because of the reduced tip-sample interaction, compared to contact mode AFM, and the ability to acquire high-resolution images while interrogating the sample's material composition through phase imaging. Despite the reduced tip-sample interaction, tip and sample wear can occur through gradual atomic scale processes that can significantly accumulate due to the high frequency of the tip-sample interaction and through high intermittent contact stresses. Starting from existing analytical formulations, we introduce a method for selecting an appropriate probe and free oscillation amplitude that avoids exceeding a critical contact stress to minimize tip/sample damage. The approach is presented for the case of both a Hertzian- and a Derjaguin-Müller-Toporov-like tip-sample contact. Stress maps and related simplified formulas are provided that enable one to determine allowable free oscillation amplitudes to stay below a target contact stress for given cantilever and sample parameters (combined into a single "cantilever-sample constant" that we introduce). Experimental results show how sharp silicon tips, either uncoated or coated with diamond-like carbon and silicon nitride, interacting with a hard and wear-resistant sample (ultrananocrystalline diamond) can be preserved while attaining high-quality AM-AFM images by using our proposed scheme. We also show that using our analysis to select parameters that exceed the target contact stress indeed leads to significant tip wear. This method provides AM-AFM users with a better understanding of contact stresses and enables selection of AM-AFM cantilevers and experimental parameters that preserve the tip for long periods of use and prevents the sample from damage.

Mechanics of interaction and atomic-scale wear of amplitude modulation atomic force microscopy probes.

Wear is one of the main factors that hinders the performance of probes for atomic force microscopy (AFM), including for the widely used amplitude modulation (AM-AFM) mode. Unfortunately, a comprehensive scientific understanding of nanoscale wear is lacking. We have developed a protocol for conducting consistent and quantitative AM-AFM wear experiments. The protocol involves controlling the tip-sample interaction regime during AM-AFM scanning, determining the tip-sample contact geometry, calculating the peak repulsive force and normal stress over the course of the wear test, and quantifying the wear volume using high-resolution transmission electron microscopy imaging. The peak repulsive tip-sample interaction force is estimated from a closed-form equation accompanied by an effective tip radius measurement procedure, which combines transmission electron microscopy and blind tip reconstruction. The contact stress is estimated by applying Derjaguin-Müller-Toporov contact mechanics model and also numerically solving a general contact mechanics model recently developed for the adhesive contact of arbitrary axisymmetric punch shapes. We discuss the important role that the assumed tip shape geometry plays in calculating both the interaction forces and the contact stresses. Contact stresses are significantly affected by the tip geometry while the peak repulsive force is mainly determined by experimentally controlled parameters, specifically, the free oscillation amplitude and amplitude ratio. The applicability of this protocol is demonstrated experimentally by assessing the performance of diamond-like carbon-coated and silicon-nitride-coated silicon probes scanned over ultrananocrystalline diamond substrates in repulsive mode AM-AFM. There is no sign of fracture or plastic deformation in the case of diamond-like carbon; wear could be characterized as a gradual atom-by-atom process. In contrast, silicon nitride wears through removal of the cluster of atoms and plastic deformation.

A simple and low-cost device for generating hyperpolarized contrast agents using parahydrogen.

A detailed description of the construction and use of a device for hyperpolarization of select contrast agents is presented. The device is based on molecular incorporation of the spin-order inherent to parahydrogen, followed by order transfer to a metastable heteronuclear alignment. Design considerations and experimental results relating to catalyst/solvent choice and handling, solvent heating, efficient gas entrainment and spin-order transfer are described. The resulting degree of hyperpolarization is shown to be substantial, ranging from a few to over 50%, depending on the choice of target molecule. Finally, the use of the hyperpolarized agent is demonstrated in a series of in vivo images.

Improved technique for measurement of regional fractional ventilation by hyperpolarized 3He MRI.

Quantitative measurement of regional lung ventilation is of great significance in assessment of lung function in many obstructive and restrictive pulmonary diseases. A new technique for regional measurement of fractional ventilation using hyperpolarized 3He MRI is proposed, addressing the shortcomings of an earlier approach that limited its use to small animals. The new approach allows for the acquisition of similar quantitative maps over a shortened period and requires substantially less 3He gas. This technique is therefore a better platform for implementation in large species, including humans. The measurements using the two approaches were comparable to a great degree, as verified in a healthy rat lung, and are very reproducible. Preliminary validation is performed in a lung phantom system. Volume dependency of measurements was assessed both in vivo and in vitro. A scheme for selecting an optimum flip angle is proposed. In addition, a dead space modeling approach is proposed to yield more accurate measurements of regional fractional ventilation using either method. Finally, sensitivity of the new technique to model parameters, noise, and number of included images were assessed numerically. As a prelude to application in humans, the technique was implemented in a large animal study successfully.

Simultaneous measurement of pulmonary partial pressure of oxygen and apparent diffusion coefficient by hyperpolarized 3He MRI.

Hyperpolarized (3)He (HP (3)He) MRI shows promise to assess structural and functional pulmonary parameters in a sensitive, regional, and noninvasive way. Structural HP (3)He MRI has applied the apparent diffusion coefficient (ADC) for the detection of disease-induced lung microstructure changes at the alveolar level, and HP (3)He pulmonary partial pressure of oxygen (pO(2)) imaging measures the oxygen transfer efficiency between the lung and blood stream. Although both parameters are affected in chronic obstructive pulmonary disease (COPD), a quantitative assessment of the regional correlation of the two parameters has not been reported in the literature. In this work, a single acquisition technique for the simultaneous measurement of ADC and pO(2) is presented. This technique is based on the multiple regression method, in which a general linear estimator is used to retrieve the values of ADC and pO(2) from a series of measurements. The measurement uncertainties are also analytically derived and used to find an optimal measurement scheme. The technique was first tested on a phantom model, and then on an in vivo normal pig experiment. A case study was performed on a COPD patient, which showed that in a region of interest ADC was 29% higher while oxygen depletion rate was 61% lower than the corresponding global average values.

Measurement of pulmonary partial pressure of oxygen and oxygen depletion rate with hyperpolarized helium-3 MRI: a preliminary reproducibility study on pig model.

RATIONAL AND OBJECTIVES: Pulmonary partial pressure of oxygen (pO(2)) and oxygen depletion rate (R) are two important parameters of lung function. The dependence of hyperpolarized (3)He (HP (3)He) T(1) on local oxygen concentration provides the basis for high-resolution mapping of the regional distributions of pO(2) and R in the lung. Although the oxygen-sensitive HP (3)He magnetic resonance imaging technique has been applied in human subjects and several animal species, reproducibility studies are rarely reported in the literature. This work presents a preliminary reproducibility study on a pig model. In this study, important scan parameters, such as measurement timing and flip angle, are optimized to minimize the noise-induced measurement uncertainty. MATERIALS AND METHODS: In the in vivo study, five normal pigs and one diseased pig with simulated pulmonary emboli were scanned with a small flip angle gradient echo sequence. The pulmonary oxygen measurement was repeated two to four times in each pig. In each measurement, a series of six images were acquired with optimal timing and flip angle. The parametric maps were generated using a bin-based data processing procedure that applied the multiple regression fitting method to extract the pO(2) and R. Variations of global mean, percentiles, and regions of interest were calculated from the maps to analyze reproducibility. RESULTS: The global statistical analyses show that average variation of global mean is 10.7% for pO(2) and 23.8% for R, and that the average variation of percentiles (10th, 25th, 50th, 75th, and 90th) and interquartile range is 14.8% for pO(2) and 30.4% for R. The region-of-interest analysis on the manually selected regions shows that the average variation of mean is 12.6% for pO(2) and 21.9% for R. CONCLUSION: In this work, a preliminary study on the reproducibility of measuring pO(2) and R with HP (3)He magnetic resonance imaging on a pig model is presented.

Early changes of lung function and structure in an elastase model of emphysema--a hyperpolarized 3He MRI study.

Early changes of lung function and structure were studied in the presence of an elastase-induced model of emphysema in 35 Sprague-Dawley rats at mild (5 U/100 g) and moderate (10 U/100 g) severities. Lung ventilation was measured on a regional basis (at a planar resolution of 3.2 mm) by hyperpolarized 3He MRI at 5 and 10 wk after model induction. Subsequent to imaging, average alveolar diameter was measured from histological slices taken from the centers of each lobe. Changes of mean fractional ventilation, mean linear intercept, and intrasubject heterogeneity of ventilation were studied during disease progression. Mean fractional ventilation was significantly different between healthy controls (0.23 +/- 0.04) and emphysematous animals at both time points in the 10-unit group (0.06 +/- 0.02 and 0.12 +/- 0.05, respectively). Changes in average alveolar diameter were not statistically observable until the 10th wk between healthy (37 +/- 10 microm) and emphysematous rats (73 +/- 25 and 95 +/- 31 microm, for 5 and 10 units, respectively). Assessment of function-structure correlation suggested that the majority of the decline in fractional ventilation occurred in the first 5 wk, while enlargement of alveolar diameters appeared primarily between the 5th and 10th wk. A thresholding metric, based on the 20th percentile of fractional ventilation over the entire lung, was utilized to detect the onset of the disease with confidence, independent of whether the regional ventilation measurements were normalized with respect to the delivered tidal volume and estimated functional residual capacity of each individual rat.

Optimization of scan parameters in pulmonary partial pressure oxygen measurement by hyperpolarized 3He MRI.

The dependence of hyperpolarized (HP) (3)He T(1) on local oxygen concentration provides the basis for measuring the partial pressure of oxygen (pO(2)) and oxygen depletion rate (R) in the lungs. Precise measurements of this type are difficult because the oxygen effect manifests itself through a decay of signal, leading to noisy images at the end of the series. The depolarization caused by RF excitation pulses further complicates the problem. It is therefore important to optimize scan parameters, such as measurement timing and flip angle, to obtain accurate and reproducible measurements. This work presents a new single-acquisition technique in conjunction with the multiple regression fitting method for data evaluation. Analytical expressions for the measurement uncertainties are derived. A total of four types of single-acquisition timing schemes are investigated; simulation shows a large uncertainty variation between these schemes (pO(2): 7.5-30.2%; R: 47.4-173.7%). A basic procedure for optimizing scan parameters is then described. A phantom experiment was conducted to verify the simulation results. Repeated in vivo measurements with the optimal scheme in a rabbit experiment showed that average variation of global mean is 6.2% for pO(2) and 12.0% for R, and that the average variation of percentiles (10th, 25th, 50th, 75th, and 90th) is 8.7% for pO(2) and 19.0% for R.

Hyperpolarized 13C MRI of the pulmonary vasculature and parenchyma.

The study of lung perfusion in normal and diseased subjects is of great interest to physiologists and physicians. In this work we demonstrate the application of a liquid-phase hyperpolarized (HP) carbon-13 ((13)C) tracer to magnetic resonance imaging (MRI) of the pulmonary vasculature and pulmonary perfusion in a porcine model. Our results show that high spatial and temporal resolution images of pulmonary perfusion can be obtained with this contrast technique. Traditionally, pulmonary perfusion measurement techniques have been challenging because of insufficient signal for quantitative functional assessments. The use of polarized (13)C in MRI overcomes this limitation and may lead to a viable clinical method for studying the pulmonary vasculature and perfusion.

Measurements of regional alveolar oxygen pressure using hyperpolarized 3He MRI.

RATIONALE AND OBJECTIVES: The aim of this work is to review hyperpolarized (HP) helium-3 (3He) magnetic resonance imaging (MRI) methods to measure regional alveolar oxygen partial pressure (P(A)O2) and oxygen depletion rate (R) in the lung. We point out limitations of the methods and suggest improvements to increase their accuracy. MATERIALS AND METHODS: P(A)O2 and R can be extracted from series of HP gas images acquired during breath hold by making use of the depolarizing effect of oxygen on HP gas. To separate oxygen-induced depolarization from other depolarizing effects, several techniques can be used. We review currently used techniques and point out their advantages and limitations. RESULTS: We show that the precision of oxygen measurements depends on a variety of parameters and can vary within the measurement volume. Accuracy of the measurement also can be influenced by diffusion of oxygen and polarized 3He and generally is different for single-slice and multislice measurements. We present numerical simulations, phantom data, and in vivo data for illustration. CONCLUSION: HP 3He MRI is a noninvasive, nonionizing, and repeatable imaging method that allows for quantitative analysis of lung function. The current techniques for measuring P(A)O2 have the potential to deliver clinically relevant functional images.