Between the city and the farm: food environments in artisanal mining communities in Upper Guinea.

OBJECTIVE: Artisanal and small-scale mining (ASM) is a widespread livelihood in low- and middle-income countries; however, many in ASM communities face high levels of poverty and malnutrition. The food environments in ASM communities have non-agricultural rural characteristics that differ from those in urban and agricultural rural areas examined in much existing food environment literature. DESIGN: We examine these complex external and personal food environments in ASM communities via a study using qualitative and quantitative methods. Market surveys and a cross-sectional household survey, plus qualitative mining site non-participant observations and in-depth structured interviews, were conducted in three waves. SETTING: Eighteen study sites in ASM communities in northern Guinea. PARTICIPANTS: Surveys covered mothers in mining households with young children (n 613); in-depth interviews engaged caregivers of young children (n 45), food vendors (n 40) and young single miners (n 15); observations focused on mothers of young children (n 25). RESULTS: The external food environment in these ASM communities combines widespread availability of commercially processed and staple-heavy foods with lower availability and higher prices for more nutritious, non-staple foods. Within the personal food environment, miners are constrained in their food choices by considerable variability in daily cash income and limited time for acquisition and preparation. CONCLUSIONS: We demonstrate that ASM communities have characteristics of both urban and rural populations and argue for greater nuance and appreciation of complexity in food environment research and resultant policy and programming.

The Window Test: A Simple Bedside Method to Detect Radial Deviation of the Wrist Commonly Seen in Posterior Interosseous Nerve Palsy.

BACKGROUND: Posterior interosseous nerve palsy (PINP) is a disorder caused by damage to the posterior interosseous nerve, resulting in weak extension of the wrist and fingers as well as radial deviation of the wrist. METHODS: This study analyzed a new type of evaluation for PINP in hopes of increasing ease of diagnosis and earlier detection of the disorder. The window test is performed by the examiner laying hands on the ulnar aspect of the patient's pronated forearm while the patient tries to extend the wrist. A positive test is obtained when a gap (window) appears between the examiner's forearm and the patient's hand. Laypeople, medical students, residents, and practicing providers were assessed prospectively on their ability to correctly diagnose PINP by observing one hand, by observing both hands and by using the window test. RESULTS: The window test was consistently found to be the most effective method of evaluation, as it increased the accuracy of diagnosis in all groups surveyed. Additionally, case studies were performed using the window test on patients, further demonstrating the efficacy of the test by confirming wrist radial deviation. CONCLUSIONS: The window test introduces a reference frame making it easier to assess wrist radial deviation and offering a simple evaluation that can be administered by virtually anyone. These findings indicate that the implementation of the window test will increase the accuracy and effectiveness of PINP diagnosis, thus allowing early diagnosis and better management.