Measuring Accessibility to Medical Centers in Isfahan City Using 2SFCA Method

AbstractOne of the most important challenges facing policymakers and urban planners in recent decades is the issue of accessibility to a variety of urban services. The main purpose of this study was thecalculation of the accessibility of census blocks to medical centers using the Two-Step Floating Catchment Area (2SFCA) method in Isfahan City. In the present study, according to the conditions with and without the limitations of the accessibility radii, different types of distance decay functions were used. The results showed that the 2SFCA method with the use of the cumulative opportunity negative linear function had the highest average of correlation for calculating accessibility to medical centers in comparison with other functions. Calculation of average accessibility in the 15 main regions of Isfahan City showed that the central regions (3, 1, and 5) had the highest decrease and the marginal regions (9, 8, and 11) had the highest increase in the unlimited compared to the limited mode. In general, based on the obtained results of 2SFCA method and the calculated Gini index, the level of inequality in accessibility of census blocks to health services was high in Isfahan City and this inequality increased in terms of accessibility to both hospitals and clinics. Since the extended 2SFCA method has a high capability for assessing supply and demand, as well as catchment area, application of this method can provide a great help for managers and planners in theassessment of the population’s access to a variety of services, such as emergency services and healthcare.Keywords: spatial accessibility, 2SFCA method, distance decay function, medical centers, Isfahan IntroductionOne of the most important challenges faced by policymakers and urban planners in recent decades has been the subjct of access to a variety of urban services. Hospital and clinic centers as the most important urban facilities play an important role in serving people. handeling access to healthcare requires examining the factors, such as spatial distribution of services and demands. Distribution of healthcare centers can affect ease of accessibility for applicants. As health is the basis of social, economic, political, and cultural developments of human societies, identifying deprived areas in terms of accessibility and planning for equitable accessibility to health services for all members of society are essential. MethodologyIn the present study, the Two-Step Floating Catchment Area Method (2SFCA) was employed to calculate the access of census blocks to medical centers (hospitals and clinics) in the city of Isfahan for limited and unlimited accessibility radii. To define the most appropriate distance decay function in the 2SFCA method, the average of Pearson’s correlation coefficient between the accessibility values ​​obtained from different distance decay functions was used. The distance decay function with the highest mean correlation of accessibility values compared to other functions was determined as the most appropriate function in the 2SFCA method. Also, the Lorenz curve and Gini coefficient were applied to compare inequalities of access to medical centers in Isfahan. Results and DiscussionThe results showed that the use of the negative linear cumulative opportunity distance decay function had the highest average correlation in the accessibility values compared to other functions. In the case of limited accessibility radius, the central regions and some northwest and east areas had the highest accessibility to hospitals. In the case of unlimited radius, the central areas had the most accessibility, while accessibility decreased as the distance from these areas increased. Calculation of the average accessibility in the 15 main regions of Isfahan showed that the central (3, 1 and 5) and marginal (9, 8, and 11) regions had the highest decrease and increase in the unlimited compared to the limited mode, respectively. Also, the sensitivity analysis of accessibility to hospitals showed that Al-Zahra and Hazrat Zahra hospitals in Districts 5 and 14 had the greatest impacts on the accessibility of cesus blocks to hospital services in Isfahan City. Comparing the accessibility of census blocks to both hospitals and clinics with accessibility only to hospitals showed an increase in accessibility in the central areas of the city due to the greater concentration of clinics in those areas. However, in the case of combination of hospitals and clinics, the Gini coefficient was equal to 0.60, which showed an increase of 0.04 compared to the case of accessibility only to hospitals, which indicated that inequality was higher in the combinatorial case. ConclusionConsidering the supply and demand simultaneously, the 2SFCA method can provide a more realistic assessment of the accessibility status of census blocks to medical services. In general, based on the obtained results by this method and due to considering the limited radius of accessibility and calculating the Gini index, the level of inequality in the accessibility of census blocks to health services was high in Isfahan City, while this inequality increased in the case of  accessibility to both hospitals and clinics. References- Apparicio, P., Gelb, J., Dubé, A. S., Kingham, S., Gauvin, L., & Robitaille, É. (2017). The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues. International Journal of Health Geographics, 16(1), 1-24.- Bryant Jr, J. and Delamater, P. L. (2019). Examination of spatial accessibility at micro- and macro-levels using the enhanced two-step floating catchment area (E2SFCA) method. Annals of GIS, 25(3), 219-229.- Chatterjee, S. and Hadi, A. S. (2006). Regression analysis by example. 4th Ed., John Wiley & Sons.- Chen, X. and Jia, P. (2019). A comparative analysis of accessibility measures by the two-step floating catchment area (2SFCA) method. International Journal of Geographical Information Science, 33(9), 1739-1758.- Dai, D. (2010). Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health & Place, 16(5), 1038-1052.- Dewulf, B., Neutens, T., De Weerdt, Y., & Van de Weghe, N. (2013). Accessibility to primary health care in Belgium: an evaluation of policies awarding financial assistance in shortage areas. BMC Family Practice, 14(1), 1-13.- Goswami, S., Murthy, C. A., & Das, A. K. (2018). Sparsity measure of a network graph: Gini index. Information Sciences, 462, 16-39.- Hashtarkhani, S., Kiani, B., Bergquist, R., Bagheri, N., Vafaeinejad, R., & Tara, M. (2020). An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas. The International Journal of Health Planning and Management, 35(3), 788-798.- Jamtsho, S., Corner, R., & Dewan, A. (2015). Spatio-temporal analysis of spatial accessibility to primary health care in Bhutan. ISPRS International Journal of Geo-Information, 4(3), 1584-1604.- Kiran, K. C., Corcoran, J., & Chhetri, P. (2020). Measuring the spatial accessibility to fire stations using enhanced floating catchment method. Socio-Economic Planning Sciences, 69, 100-673.- Luo, W. (2004). Using a GIS-based floating catchment method to assess areas with shortage of physicians. Health & Place, 10(1), 1-11.- Luo, W. and Qi, Y. (2009). Health & place: An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians. Health & Place, 15(4), 1100-1107.- Luo, W. and Wang, F. (2003). Measures of spatial accessibility to health care in a GIS environment: Synthesis and a case study in the Chicago region. Environment and Planning B: Planning and Design, 30(6), 865-884.- McGrail, M. R. and Humphreys, J. S. (2014). Measuring spatial accessibility to primary health care services: Utilising dynamic catchment sizes. Applied Geography, 54, 182-188.- Ngui, A. N. and Apparicio, P. (2011). Optimizing the two-step floating catchment area method for measuring spatial accessibility to medical clinics in Montreal. BMC Health Services Research, 11(1), 1-12.- Peng, Z. R. (1997). The jobs-housing balance and urban commuting. Urban Studies, 34(8), 1215-1235.- Park, J. and Goldberg, D. W. (2022). An Examination of the Stochastic Distribution of Spatial Accessibility to Intensive Care Unit Beds during the COVID-19 Pandemic: A Case Study of the Greater Houston Area of Texas. Geographical Analysis.- Radke, J. and Mu, L. (2000). Spatial decompositions, modeling and mapping service regions to predict access to social programs. Geographic Information Sciences, 6(2), 105-112.- Wang, F. (2000). Modeling Commuting Patterns in Chicago in a GIS Environment: A Job Accessibility Perspective. Professional Geographer, 52(1), 120-133.- Wang, L. (2007). Immigration, ethnicity, and accessibility to culturally diverse family physicians. Health and Place, 13(3), 656-671.- Wang, F. (2012). Measurement, optimization, and impact of health care accessibility: a methodological review. Annals of the Association of American Geographers, 102(5), 1104-1112.- Zhang, S., Song, X., & Zhou, J. (2021). An equity and efficiency integrated grid-to-level 2SFCA approach: spatial accessibility of multilevel healthcare. International Journal for Equity in Health, 20(1), 1-14

Immunoexpression profile of hypoxia-inducible factor (HIF) targets in potentially malignant and malignant oral lesions: a pilot study

Oral potentially malignant disorders (OPMD) are associated with an increased risk of oral squamous cell carcinoma (OSCC). OSCC has an aggressive profile and is the most prevalent among different head and neck malignancies. Most OSCC patients are diagnosed with advanced stage tumors and have a poor prognosis. Cancer cells are able to reprogram their metabolism, even in the presence of oxygen, enhancing the conversion of glucose to lactate via the glycolytic pathway, a phenomenon mainly regulated by hypoxia-inducible factor (HIF) signaling. Thus, several glycometabolism-related biomarkers are upregulated.  Objectives: This study aimed to evaluate the immunoexpression of the HIF targets GLUT1, GLUT3, HK2, PFKL, PKM2, pPDH, LDHA, MCT4, and CAIX in OPMD and OSCC samples, in order to identify potential correlations between biomarkers’ immunoexpression, clinicopathological features, and prognostic parameters. Methodology: OSCC and OPMD samples from 21 and 34 patients (respectively) were retrospectively collected and stained for the different biomarkers by immunohistochemistry. Results: CAIX and MCT4 expressions were significantly higher in OSCC samples when compared with OPMD samples, while the rest were also expressed by OPMD. GLUT3 and PKM2 alone, and the concomitant expression of more than four glycometabolism-related biomarkers were significantly correlated with the presence of dysplasia in OPMD. When considering OSCC cases, a trend toward increased expression of biomarkers and poor clinicopathological features was observed, and the differences regarding HK2, PFKL, LDHA and MCT4 expression were significant. Moreover, HK2 and CAIX were correlated with low survival rates. GLUT1 and GLUT3 were significantly associated with poor outcome when their expression was observed in the hypoxic region of malignant lesions. Conclusion: OPMD and OSCC cells overexpress glycolysis-related proteins, which is associated with aggressive features and poor patient outcome. Further research is needed to deeply understand the glycolic phenotype in the process of oral carcinogenesis

Perfil de imuno-expressão de proteínas alvo do HIF (hypoxia-inducible factor) em lesões orais pré-malignas e malignas: um estudo piloto

Dissertação de mestrado em Genética MolecularIntrodução: O carcinoma da cavidade oral é a décima sexta causa de morte por cancro. Tem um perfil agressivo e é o cancro mais prevalente entre os diferentes subtipos de cancro da cabeça e pescoço. A maioria dos doentes com carcinoma da cavidade oral é diagnosticada com tumores em estádios avançados, e apresentam um prognóstico adverso. Assim, é urgente procurar novos biomarcadores de prognóstico e identificar novas estratégias terapêuticas. A ocorrência de alterações metabólicas é uma dos pilares do cancro. As células malignas são capazes de reprogramar o seu metabolismo, mesmo na presença de oxigénio, aumentando a conversão de glicose em lactato através da via glicolítica, num fenómeno conhecido como “Efeito Warburg”. Para tal, várias proteínas relacionadas com o metabolismo glicolítico sofrem um aumento na sua expressão. Objetivo: Pretendeu-se avaliar a imunoexpressão de GLUT-1, GLUT-3, HK-II, PFK-L, PKM-2, pPDH, LDH-A, MCT-4 e CA-IX em lesões pré-malignas e em amostras de carcinoma de células escamosas (CCE), a fim de identificar possíveis correlações entre a imunoexpressão dos biomarcadores e parâmetros clínico-patológicos e de prognóstico. Materiais e Métodos: Neste estudo retrospectivo foram recolhidas amostras de CCE de 21 doentes e amostras de lesões orais pré-malignas de 34 doentes, bem como os seus dados clínico-patológicos e de seguimento. Cortes histológicos das amostras fixadas em formol e incluídas em parafina foram submetidos a imunohistoquímica, para identificação das proteínas GLUT-1, GLUT-3, HK-II, PFK-L, PKM-2, pPDH, LDH-A, MCT-4 e CA-IX. Resultados: Verificou-se que a expressão de CA-IX, MCT-4, LDH-A, PKM-2 e PFK-L nos casos de CCE era significativamente superior à expressão nas amostras de lesões pré-malignas. Foi observada uma tendência de correlação entre o aumento da expressão dos biomarcadores e a agressividade tumoral, sendo a associação significativa para as proteínas HK-II e LDH-A; a expressão aumentada de HK-II e a CA-IX associou-se a uma diminuição das taxas de sobrevivência. Tal foi igualmente notado para as proteínas GLUT-1 e GLUT-3 quando a sua expressão foi observada no compartimento hipóxico das lesões malignas. Conclusão: As células malignas do CCE apresentam expressão aumentada de proteínas glicolíticas, e tal associa-se com a agressividade tumoral e com um prognóstico adverso dos doentes com CCE. São necessários estudos adicionais que explorem o papel do fenótipo glicólico na carcinogénese oral.Background: Oral cancer is the sixteenth leading cause of cancer death. It has an aggressive profile and it is the most prevalent cancer among different subtypes of head and neck cancer. The majority of oral cancer patients are diagnosed with advanced stage tumors and display a poor prognosis. Thus, it is urgent to investigate new prognostic biomarkers and identify novel therapeutic strategies. The occurrence of metabolic alterations is one of the hallmarks of cancer. Cancer cells are able to reprogram their metabolism, even in the presence of oxygen, enhancing glucose conversion to lactate through the glycolytic pathway, a phenomenon known as “Warburg effect”. For this purpose, several metabolism related proteins are upregulated. Objective: The aim of the study was to evaluate the immunoexpression of GLUT-1, GLUT-3, HK-II, PFK L, PKM-2, pPDH, LDH-A, MCT-4, and CA-IX in premalignant lesions and in oral squamous cell carcinoma samples, in order to identify potential correlations between biomarkers’ immunoexpression, clinicopathological and prognostic parameters. Material and Methods: In this retrospective study, oral squamous cell carcinoma (OSCC) samples from 21 patients and premalignant (PM) oral samples from 34 patients were collected, as well as their clinicopathological and follow up data. The formalin-fixed, paraffin-embedded tissues were stained for GLUT-1, GLUT-3, HK-II, PFK-L, PKM-2, pPDH, LDH-A, MCT-4, and CA-IX by immunohistochemistry. Results: CA-IX, MCT-4, LDH-A, PKM-2 and PFK-L expressions were significantly increased in OSCC samples when compared to premalignant lesions. A tendency was observed towards increased biomarkers’ expression and poor clinicopathological features, being the differences significant regarding HK-II and LDH-A expression; HK-II and CA-IX were additionally correlated with low survival rates. GLUT-1 and GLUT-3 were also significantly associated with a poor outcome when their expression was observed in the hypoxic compartment of the malignant lesions. Conclusion: Oral cancer cells overexpress glycolysis-related proteins, and this associates with aggressiveness features and a poor outcome of OSCC patients. Further research into a deep understanding of the glycolic phenotype in oral carcinogenesis in needed.The work presented in this thesis was performed in the Life and Health Sciences Research Institute (ICVS), University of Minho. Financial support was provided by: - the projects NORTE-01-0145-FEDER-000039 and NORTE-01-0145-FEDER-000055, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF); - National funds, through the Foundation for Science and Technology (FCT) - project UIDB/50026/2020 and UIDP/50026/2020; - ICVS Scientific Microscopy Platform, member of the national infrastructure PPBI - Portuguese Platform of Bioimaging (PPBI-POCI-01-0145-FEDER-022122)

Association of the ability to taste Phenylthiocarbamide with sex and smoking

Introduction: The ability to taste Phenylthiocarbamide (PTC), has been long studied from genetics, epidemiologic and evolutionary point of view. This ability is associated with the ability of tasting other bitter substances which mostly are toxic. Natural selection is involved in the maintenance of the allelic frequency of PTC. Variation in the frequency of tasters and non-tasters could reflect the food preferences and dietary habits. Moreover, it can be a marker for diet-related diseases. The frequency of PTC taste sensitivity has been studied in many populations. However, no study in this regard has been reported in Iran.  The aim of this research was to determine the frequency of PTC tasters and not-tasters in a population from Iran and also the association of sex and smoking with the ability to taste PTC.   Methods:  In this research, 175 individuals from Shiraz University or their families were examined regarding the ability to taste PTC.   Results: The frequency of T, and t alleles was 0.58 and 0.42, respectively. There was 82.3% taster versus 17.7% non-taster in this population. There was significant difference (p=0.007, OR=4.044) between male and female regarding the ability of tasting PTC. Moreover, there was more non-taster among smokers compared to non-smokers (p= 0.002, OR=0.278).   Conclusion: To the best of the authors’ knowledge, this is the first study to investigate the frequency of PTC tasters in Iran. We have shown that, similar to studies from other populations, the frequency of PTC tasters is higher compared to non-tasters in our population. Moreover, there are more tasters among women and non-smokers compared to men and smokers, respectively. Considering that in Iran, women have an important role in providing food recepies, being more taster would help them probably to choose healtier ingredients for food recepies. In addition, investigating the connenctions between taste perception and smoking may help us to find a reliable indicator for smoking susceptibility. However, larger sample size and genetic tests are necessary to draw a more comperihensive conclusion. &nbsp