Title: Relationship between covid-pandemic anxiety and sleep disorder with menstrual disorders
among female medical workers
Version: 3 Date: 01 Mar 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I hav read carefully the manuscript """"Menstrual cycle changes and
their association with anxiety and sleep disturbances in female medical staff during COVID-19
epidemic: A Cross-sectional Survey in China"". Despite I appreciate the efforts in design and
performing this survey study, the article needs extensive editing and the authors should clarify
several elements to allow a proper data interpretation.
REQUESTED REVISIONS:
I recommend to take into account the following elements:
- An editing by a native speaker seems mandatory to improve grammar and style.
- Methods: the sample size analysis (power calculation) should have been calculated on the
primary outcome.
- Methods: the authors should clarify what they considered as primary outcome (just one, on
which the sample size analysis should have been performed) and secondary outcomes.
- Methods: did the authors followed the CROSS (Consensus-Based Checklist for Reporting
of Survey Studies) guidelines, validated by the EQUATOR (Enhancing the QUAlity and
Transparency Of health Research) network? This should have been considered mandatory,
taking into account the type of study.
- Methods: authors should clarify what they mean with “fought against COVID-19”. Were
the participants employed in day/night shifts? How many day/night shifts per week? Detailed
information about staffing, work organization and working hours should be provided.
- Methods: the authors should give more detailed information about the random sampling
method.
- Methods: were the participants randomly selected among those who agreed, or were they
randomly selected and then asked to agree to answer the survey?
- Methods: “We added the medical staff of the sampled sample to WeChat and pulled them into
the group, informed consent was given in the group”; this raises serious concern on the validity
of the informed consent, obtained in a chat group. Indeed, the consent should be discussed and
signed individually.
- Methods: authors declared that they included women 18-45 years. Many women around 45
years may be already in perimenopausal status, characterized by menstrual cycle changes: how
did the authors rule out this potential bias?
- Methods: authors did not exclude women affected by gynecological diseases. This represents
a major point of bias for the whole data analysis.
- Methods: authors did not exclude women affected by sleep disturbance (already present before
the COVID pandemic). This represents a major point of bias for the whole data analysis.
- Results: Table 1, “Time, seconds (mean ± SD)” about what?
- Results: menstrual cycle characteristics must be defined as follows. For frequency, short:
shorter than 25 days; normal: between 25 and 35 days; long: longer than 35 days. For duration,
short: shorter than 3 days; normal: between 3 and 7 days;  long: longer than 7 days. For quantity,
abundant: more than 80 mL; normal between 20 and 80 mL; scares: less than 20 mL.
- Results: units of measure must be added to each one of the tables.
- Discussion: I recommend to discuss that COVID-19 vaccine was associated with menstrual
cycle irregularities, which were found to self-resolve in approximately half the cases within two
months (authors may refer to: PMID: 35350834; PMID: 36804196).
- Discussion: authors should discuss the novel data suggesting changes in menstrual volume and
changes in menstrual cycle length as consequences of SARS-CoV-2 infection, namely decreased
menstrual volume and a prolonged cycle, which seem independent by the severity of COVID-19
(authors may refer to: PMID: 36836546)."