Background: Individuals with psychosis have reduced life expectancy and this is largely driven by cardiometabolic disease. Cardiometabolic risk increases with age and duration of psychotic illness. Anthropometric and physiologic abnormalities have been identified among individuals with at-risk mental state (ARMS) for psychosis. The prevalence of cardiometabolic disease is disproportionately higher in lower middle-income countries (LMIC); however, literature on cardiometabolic disease in individuals with psychosis spectrum disorders in LMIC is scarce. Method: This is a cross-sectional secondary analysis of data from two large randomised controlled trials that recruited individuals with ARMS (n=326) and schizophrenia (SCZ; n=303) from inpatient and outpatient settings in Pakistan. All participants completed anthropometric and physiological assessments. Results: There was a statistically significant difference in BMI between groups, 21.42 (SD=4.11) in ARMS and 23.31 (SD=5.41) in the SCZ group (p=0.001). Although mean values were within the normal range, 17.8% (n=58) of ARMS individuals and 33.1% (n= 100) SCZ individuals were overweight or obese. Waist circumference was 32.75in (SD=3.13) in the ARMS group and 32.16in (SD=5.18) in SCZ. Although waist circumference was higher in ARMS, this was not statistically or clinically significant. The pulse rate and blood pressure in both groups were within normal range. Conclusion: We found evidence of abnormal anthropometric and physiological parameters that would indicate that individuals with psychotic-spectrum disorders in Pakistan are at an elevated cardiometabolic risk.

Objective: To assess the acceptability, safety and efficacy of the PPH Butterfly, a new uterine compression device, in women with postpartum haemorrhage (PPH). Design: A phase two clinical device trial using matched historical controls, with accompanying grounded theory study. Setting: UK university consultant obstetric unit. Population: women with PPH after vaginal birth unresponsive to initial oxytocin therapy. Outcomes were compared to historical controls matched on blood loss, parity and type of birth. Methods: after oral consent, trained staff used the device in additional to normal care. Main Outcome Measures: The primary outcome was additional blood loss >1000mls. Qualitative interviews assessed device feasibility and acceptability. Results: Of the 57 recruits, two-thirds were primiparous and almost half had undergone operative birth. Two percent of recruited women had additional blood loss of over 1000mls compared to 8% of 113 controls (adjusted odds ratio 0.13, 95% CI (0.02 to 1.09)). Women treated with the device received significantly more additional treatments and had higher rates of exclusive breast-feeding at discharge. There were no serious adverse events related to the device. In 47 interviews, participants, birth partners, clinicians and attending midwives viewed the device positively. Clinicians found it useful to stop blood loss and diagnose the source of bleeding. Conclusions: the PPH Butterfly is acceptable and may have clinical benefits: it is a promising device for PPH management. Funding: National Institute for Health Research invention for innovation (i4i) program (II-LA-0715-200008) Keywords: postpartum haemorrhage, childbirth, oxytocin, third stage of labour, uterine compression. Registration: prospective ISRCTN (15452399); www.isrctn.com/ISRCTN15452399

Mini-commentary on BJOG-20-0063.R1: Association of maternal attention deficit hyperactivity disorder and preterm birth: a cohort study