Hygiene: new hopes, new horizons

Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

Lateral ligamentous instability of the ankle: a method of surgical reconstruction by a modified Watson-Jones technique

Forty-nine cases of lateral ligamentous instability of the ankle have been reviewed. Forty-one have been personally examined. Eight have been evaluated by questionnaire follow-up. The end results have been universally good. The results have been based on a subjective evaluation by the patient, 92% regarding the end results of the procedure to be excellent. In regard to function, 92% of the patients have been able to resume their preinjury activity. The evidence of instability of the ankle joint can be determined by preoperative x-ray examination. However, careful history and physical examination obviate the need for x-ray studies in most cases. Operative findings have confirmed our preoperative evaluation in all cases. The modification of the Watson-Jones procedure, using the peroneus longus, enables the operating surgeon use of a much greater tendon in reconstruction of the lateral ligamentous structures. No change in the function of the foot has been noted in the reported cases.