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XLI Reunión Anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE)
S18
There are clear regional disparities in access to food, with more iso‑
lated islands having less variety, quality, and quantity of healthy
foods available. Its topography and weather limit agricultural prac‑
tices and transportation, but income, education, culture, and policies
subsidizing the production of meat and dairy were also identified as
important barriers to access and availability of healthy food.
Conclusions/Recommendations: Food insecurity is a public
health concern in this European outermost region, and geography,
topography, and weather affect the availability of certain food prod‑
ucts, but economic and agricultural policies also seem to be central
determinants. The solution for food insecurity demands an interdis‑
ciplinary dialogue and multipronged strategies to allow sustainable,
lasting changes in the Azores and in similar regions.
974. WHAT MOTIVATES ADOLESCENTS TO USE URBAN
GREEN SPACES, AND HOW DO THEY USE THEM? A FOCUS
GROUP STUDY
D. Queiroz Almeida, M. Sampaio Costa, J.P. Silva, H. Barros, T. Leão,
A.I. Ribeiro
EPIUnit-Instituto de Saúde Pública, Universidade do Porto;
Laboratório para a Investigação Integrativa e Translacional em Saúde
Populacional (ITR); Faculdade de Medicina da Universidade do Porto;
Instituto de Sociologia da Universidade do Porto, Faculdade de Letras
da Universidade do Porto.
Background/Objectives: Urban green spaces constit ute important
destinations for adolescents, where they can practice the activities
they enjoy, away from adult surveillance, while cultivating their so‑
cial life, health, and well‑b eing. However, there is a lack of adolescent‑
informed understanding of how these spaces are used. We aimed to
investigate the modes of green space utilization in adolescents, as
well as their motivations for utilization, and if the perception and use
changed with the COVID‑19 lockdowns.
Methods: This study used a focus group design. Participants were
invited from the Generation XXI cohort (Porto Metropolitan Area,
Portugal), stratified by socioeconomic status (SES), with an equal
number of participants by sex. A thematic analysis was conducted
using deductive inductive approach.
Results: A total of 7 focus groups and 34 participants aged 15‑16
years old were included. Most participants v isited green spaces regu‑
larly (daily or weekly), but many also used them seasonally. Partici‑
pants from lower SES reported more regular and less seasonal use.
The main mot ivations for green space utilization were physical activ‑
ity and exercise (reported more by male participants), followed by
sociability (with peers, family, or new people), perceived benefit to
health (respiratory health and wellbeing and relaxation), walking
pets, aesthetic appreciation, and the need to be in contact with na‑
ture. The main reasons for not using green spaces were lack of time
and lack of habit. Most reported using public urban parks and gar‑
dens, usually near their residence or school, but a few used urban
forests and meadows (mostly females) and zoological garden s. During
the lockdown, most adolescents reduced green space utilization,
mainly due to fear of contract ing COVID‑19. However, some increased
it to escape confinement. After lockdowns, most participants main‑
tained or increased their levels of green space utilization. Those who
did, did it for their wellbeing and relaxation and also a heightened
awareness of the importance of nature.
Conclusions/Recommendations: This study showed the modes
and motivations to use green spaces in youth and identified impor‑
tant SES‑ and gender‑based differences. These results may help to
improve the design of quantitative studies on green space and health
and provide evidence for decision makers so that they c an better plan
green spaces and improve them, leading to a higher use by adoles‑
cents.
Funding: UIDB/04750/2020, LA/P/0064/2020, PTDC/GES‑
OUT/1662/2020, CEECIND/02386/2018.
939. YOUTH-LED URBAN GREEN: EXPLORING YOUTH
PERSPECTIVES ON URBAN GREEN SPACES, IN A SOUTHERN
EUROPEAN CONTEXT
M. Sampaio Costa, D. Queiroz Almeida, J.P. Silva, A.I. Ribeiro,
T. Leão, H. Barros
Faculdade de Medicina da Universidade do Porto; EPIUnit-Instituto
de Saúde Pública, Universidade do Porto; Laboratório para a
Investigação Integrativa e Translacional em Saúde Populacional;
Departamento de Ciências da Saúde Pública e Forenses e Educação
Médica, Faculdade de Medicina da Universidade do Porto; Instituto
de Sociologia da Universidade do Porto, Faculdade de Letras da
Universidade do Porto.
Background/Objectives: Green spaces are essential infrastruc‑
tures in cities. They c an significant ly contribute to adolescents’ health
and wellbeing in the urban setting, being at the same time a cost‑ef‑
fective intervention to reduce health inequities and contributing to
climate‑resilient cities. Adolescents’ needs and desires regarding the
planning and design of urban green spaces tend to be neglected. We
aimed to identify facilitators, barriers, and promoters of the use of
urban green spaces by adolescents in the Porto Metropolitan Area.
Methods: We performed focus groups with adolescents from the
Generation XXI cohort (G21), stratified according to their socioeco‑
nomic status, with equal number of participants by sex. Data were
analyzed thematically using a deductive‑inductive approach.
Results: Proximity and multifunctionality of urban green spaces
were the most cited facilitators of use, by adolescents; whilst high
visitors pressure, lack of vegetation, and lack of maintenance were
identified as important barriers. Adolescents reinforced the need to
increase the number and size of urban green spaces in the Porto Met‑
ropolitan Area, while potentiating their multifunctionality by means
of equipment provision.
Conclusions/Recommendations: This study reinforces the feasi‑
bility and utility of youth‑led participatory urban design, encourag‑
ing city planners and decision‑makers to incorporate it as a routine in
urban planning, in order to promote health and wellbeing among
adolescents.
Funding: UIDB/04750/2020, LA/P/0064/2020, PTDC/GES‑
OUT/1662/2020, CEECIND/02386/2018.
748. PERSPECTIVES ON GENTRIFICATION AND HEALTH:
A PHOTOVOICE STUDY IN PORTO
J.P. Silva, C.J. Santos, E. Torres, L. Martínez‑Manrique, H. Barros,
A.I. Ribeiro
EPIUnit-Instituto de Saúde Pública UP; Laboratório para a
Investigação Integrativa e Translacional em Saúde Populacional;
Hospital Universitario de Móstoles.
Background/Objectives: Porto is currently undergoing a fast pro‑
cess of transnational gentrification. Interest about how gentrification
impacts health is still recent. Existing research has produced mixed
results and this relationship is still poorly understood. Qualitative
and participatory research may help to better understand this topic
and to empower participants. Considering this, we studied the rela‑
tionship between gentrification and health in Porto from the per‑
spectives of its residents.
Methods: We conducted a photovoice study. We compared t he val‑
ues of municipal housing taxes of the 2015‑2022 and 2006‑2009
(when the current gentrification wave was still embrionary) periods,
Gac Sanit. 2023;37(S1):S6–S56
S19
thus determ ining three ty pes of city areas: gentr ifying, deprived non‑
gentrifying, and affluent non‑gentrifying. We recruited participants
from the EPIPorto cohort to create 3 groups, 1 per area: 6 from gentri‑
fying areas, 6 from aff luent areas, and 4 from deprived areas (total: 16
participants). We offered participants an introductory photography
workshop and provided them cameras to take photos about the fol‑
lowing question: “how may gentrification impact the health of Porto
residents?” For each group, we conducted a session where partici‑
pants selected, presented and discussed the photos using the
SHOWeD method. We taped and transcribed the sessions and con‑
ducted an inductive thematic analysis of the transcripts.
Results: The analysis yielded six themes: increasing f loating popu‑
lation, housing access and displacement, construction and urban re‑
habilitation, changing local commerce, disappearing sense of place,
and general socioeconomic change. Each theme descr ibes a major set
of gentrification‑led changes that, according to the participants, has
consequences for health. Most themes comprise both beneficial ef‑
fects ‑ such as healthier behaviours, better life standards, urban reha‑
bilitation and revitalisation ‑ and harmful effects ‑ such as deepened
inequalities, higher cost of living, stress, pollution, erosion of social
ties, loss of local identity, lack of access to housing and displacement
‑ on health and well‑being. These consequences were sometimes il‑
lustrated with personal stories. Participants considered that better
policies are needed to maximise the benefits and offset the harms
generated by gentrification.
Conclusions/Recommendations: Our study identifies important
mechanisms underlying the association between gentrification and
health from the perspectives of the participants. Given the similari‑
ties between gentrification processes in Porto and other southern
European cities, our conclusions may also be relevant to the latter.
Funding: UIDB/04750/2020 LA/P/0064/2020 PTDC/GES‑
OUT/1662/2020 CEECIND/02386/2018.
562. PHOTOVOICE SOBRE LA EXPERIENCIA
DE PROFESIONALES DE ATENCIÓN PRIMARIA
EN LA PANDEMIA
I. Del Cura, E. Polentinos, P. Conde, V. García, L. Martínez,
R. Sánchez, M. Rodríguez, M. Álvarez
Unidad de Investigación, Gerencia AP Madrid; Hospital Universitario
de Móstoles; CS Periodistas; CS M. Jesús Hereza.
Antecedentes/Objetivos: La pandemia de COVID‑19 ha originado
una crisis sanitaria sin precedentes impactando en los sistemas sani‑
tarios públicos a nivel mundial. En España ha tensionado la atención
primar ia de salud (AP) hasta la pre ocupante situación act ual. Explorar
la experiencia de los profesionales de AP de la Comunidad de Madrid
en el desempeño de su rol profesional durante la pandemia y describir
las estrateg ias de afrontamiento colec tivo que pusieron en marcha en
los centros de salud.
Métodos: Estudio cualitativo con metodología participativa
Photovoice. Participaron 24 profesionales AP, medicas de familia,
enfermeras, MIR y EIR en primera línea durante las primeras olas
de la pandemia tras otorgar consentimiento informado. Muestreo
intencional seleccionando perfiles por edad, profesión y nivel so‑
cioeconómico de la zona en la que trabajan. Entre febrero y junio
2021 se realizaron 5 sesiones Photovoice 3 grupos etarios < 30, 30‑
50, ≥ 50. Tomaron fotografías relacionadas con su experiencia, se
completaron respondiendo: ¿Qué se ve? ¿Qué historia hay detrás?
¿Cómo se relaciona con tu rol profesional?; tras discusión se codi‑
ficaron en categorías temáticas con una estrategia analítica deduc‑
tiva.
Resultados: 86% mujeres. Tomaron 234 fotografías, incluyéndose
110 en el análisis final. Se consensuaron 14 categorías emergentes,
con 6 temas conceptuales relacionados con su rol profesional: Irreali‑
dad e Incertidumbre en una nueva realidad, Resistir sin protección,
desempeño profesional modificado ¿Quiénes somos?, la macro y mi‑
crogestión de la pandemia, el valor del equipo, y la transición de la
incondicionalidad al desencanto. La experiencia estuvo marcada por
situaciones personales de salud, turno de trabajo, equipo y situación
social de los barrios. Las recomendaciones consensuadas fueron a)
generales sobre la apuest a por lo público y el modelo de AP, garantizar
recursos humanos, impulsar la comunitaria y mejorar la relación y la
comunicación con los gestores b) mejora de la accesibilidad y desbu‑
rocratización con apoyo de TIC y específicas de organización interna
para el control de la pandemia c) garantizar el desarrollo de los pro‑
gramas formaticos de las especialistas d) facilitar espacios para el
encuentro y el descanso.
Conclusiones/Recomendaciones: La experiencia de las profesio‑
nales en la pandemia ha impacto en su rol e identidad profesional con
un profundo desgaste que fue diferente según edad, género y perfil
profesional. La participación en Photovoice ha ayudado a profundizar
y reflex ionar sobre cómo se ha modif icado el entorno y el rol profesio‑
nal, así como a identificar los puntos críticos de la gestión.
Financiación: Expediente COVID2020‑23 Fundación Investigación
e Innovación en AP de la Comunidad de Madrid.
507. POBREZA, ENFERMEDAD Y DISCRIMINACIÓN:
UN ESTUDIO FOTOVOZ CON PERSONAS QUE VIVEN
CON NEFROPATÍA MESOAMERICANA EN NICARAGUA
O. Ramírez‑Rubio, C. Hernández‑Zurbano, L. Martínez Manrique,
A.G. Amador, J.J. Amador‑Velázquez, C. O’Callaghan‑Gordo, A. Soto,
M González‑Quiroz, P. Conde, M Franco, M.K. Scammell, et al.
Instituto de Salud Global de Barcelona; Complejo Hospitalario
Universitario de Cáceres; Hospital Universitario de Móstoles;
Universidad de Boston; Universidad Nacional Autónoma de
Nicaragua, León; University College London; Universidad Alcalá de
Henares.
Antecedentes/Objetivos: Se ha descrito una alta prevalencia de
enfermedad renal crónica de etiología desconocida, también denom i‑
nada nefropatía mesoamericana (NeM), constituyendo una de las
principales causas de muerte en la población adulta masculina de Ni‑
caragua o El Salvador. Los estudios epidemiológicos indican que NeM
afecta de manera desproporcionada a las poblaciones económica‑
mente vulnerables y de bajos ingresos, con dispar idades significativas
en el acceso a la atención, principalmente entre aquellos que necesi‑
tan diálisis o trasplante renal. El objetivo de este estudio fue com‑
prender el contexto social, económico y ambiental de la enfermedad
desde la perspectiva de las personas directamente afectadas.
Métodos: Este proyecto utilizó dos metodologías de investigación‑
acción par ticipativa. Fotovoz permitió a los participantes doc umentar
a través de fotografías su experiencia diaria de la enfermedad, inclui‑
das las barreras de acceso a la atención médica. El mapeo corporal
sirvió para generar una lluvia de ideas sobre los temas a fotografiar al
capturar las percepciones, sensaciones y emociones desencadenadas
por la enfermedad, así como el contexto y los determinantes de la
enfermedad. Usando una estrategia de muestreo de bola de nieve en
dos de los municipios nicaragüenses más afectados, Chichigalpa y La
Paz Centro, en 2020, se reclutaron 18 hombres con NeM: 8 y 10 res‑
pectivamente.
Resultados: Se tomaron un total de 67 fotog rafías: 28 en Chichiga l‑
pa y 39 en La Paz Centro, de las cuales 47 fueron seleccionadas por los
participantes para plasmarlas en un fotolibro editado profesional‑
mente y en un video‑documental, finalista del Festival de Cine de la
OMS en 2021. Los principales temas identificados son la discrimina‑
ción en el lugar de trabajo y en la comunidad; el círculo vicioso de
pobreza y enfermedad; la importancia de los autocuidados, el déficit
de recomendaciones dietéticas adaptados culturalmente y a la capa‑