Caroline Free and colleagues systematically review a fast-moving field, that of the effectiveness of mobile technology interventions delivered to healthcare consumers, and conclude that high-quality, adequately powered trials of optimized interventions are required to evaluate effects on objective outcomes.

Caroline Free and colleagues systematically review controlled trials of mobile technology interventions to improve health care delivery processes and show that current interventions give only modest benefits and that high-quality trials measuring clinical outcomes are needed.

CUTE LOWER RESPIRATORYtract illness is the most common condition treated in primary care. 1,2 Assuming 75% of patients are prescribed antibiotics 1 and using conservative national morbidity survey estimates, 2 acute cough costs the UK National Health Service at least US $270 million in consultation costs and US $35 million to 70 million antibiotic prescription costs annually. In the United States, excess antibiotic prescribing is mainly for pharyngitis and acute bronchitis, amounting to 55% of prescriptions and costing $726 million per year. 3 A consensus has been made for limiting antibiotic use in acute lower respiratory tract infection. [4][5][6] However, recent systematic reviews 7,8 have come to diverse conclusions about the likely effectiveness of antibiotics, and the most recent Cochrane review 7 confirms a moderate effect of antibiotics on illness course; the debate continues unabated about the role of antibiotics be-For editorial comment see p 3062.

Background Water, sanitation and hygiene (WASH) interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. Objectives To evaluate the effect of interventions to improve water quality and supply (adequate quantity to maintain hygiene practices), provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps. Search methods We searched 10 English-language (including MEDLINE and CENTRAL) and three Chinese-language databases for published studies in June 2012. We searched grey literature databases, conference proceedings and websites, reviewed reference lists and contacted experts and authors. Selection criteria Randomised (including cluster-randomised), quasi-randomised and non-randomised controlled trials, controlled cohort or crosssectional studies and historically controlled studies, comparing WASH interventions among children aged under 18 years. 1 Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children (Review)

Objective. The UK Juvenile-Onset Systemic Lupus Erythematosus (JSLE) Cohort Study is a multicenter collaborative network established with the aim of improving the understanding of juvenile SLE. The present study was undertaken to describe the clinical manifestations and disease course in patients with juvenile SLE from this large, national inception cohort.Methods. Detailed data on clinical phenotype were collected at baseline and at regular clinic reviews and annual followup assessments in 232 patients from 14 centers across the UK over 4.5 years. Patients with SLE were identified according to the American College of Rheumatology (ACR) SLE classification criteria. The present cohort comprised children with juvenile SLE (n ‫؍‬ 198) whose diagnosis fulfilled >4 of the ACR criteria for SLE.Results. Among patients with juvenile SLE, the female:male sex distribution was 5.6:1 and the median age at diagnosis was 12.6 years (interquartile range 10.4-14.5 years). Male patients were younger than female patients (P < 0.01). Standardized ethnicity data demonstrated a greater risk of juvenile SLE in nonCaucasian UK patients (P < 0.05). Scores on the pediatric adaptation of the 2004 British Isles Lupus Assessment Group disease activity index demonstrated significantly increased frequencies of musculoskeletal (82%), renal (80%), hematologic (91%), immunologic (54%), and neurologic (26%) involvement among the patients over time. A large proportion of the patients (93%) were taking steroids and 24% of the patients required treatment with cyclophosphamide. Disease damage was common, with 28% of the patients having a