Reviewer’ s report
Title: Prognostic factors for future mental, physical and urogenital health and work ability in
women, 45-55 years. A six-year prospective longitudinal cohort study.
Version: 0Date: 20 Feb 2020
Reviewer: Esther Susanna Shoemaker
Reviewer's report:
BMWH-D-19-00748: Prognostic factors for work ability and health in women in "middle of life",
45-55 years, attending primary health care. A six-year prospective longitudinal cohort study
Comments to the author
Overall1.Why would you choose to have the line numbers restart at every page? Your line numbers alsodon't match the actual text. This makes it very difficult to comment. I'm sorry if you might find itmore difficult to see where each of my comments belongs to, I tried to match it closely to the linenumbers provided.
Abstract
1.Your title is very unclear overall and I would refrain from including a definition into the title2.Unclear background section. You jump from mental stress to primary care to work ability. Youdid submit this paper to a health journal but your primary motive seems to be to find out if peoplecan work? The argument here isn't clear to me.3.Too many acronyms in such a bit of text. Why would you make it so confusing for the reader?
4.Your first sentence in the conclusion section is not understandable at the moment. The following
two sentences also need restructuring.
Background
5.Line 7: there must be more recent studies on that topic6.Line 17: do you mean bio-psycho-social?; don't leave a space between reference numbers7.Line 24: rewrite this last sentence of the paragraph, it's currently unclear8.33: by 71%. A relative increase as such is very unspecific. Did it increase from 3 to 5 women;thus not important, or from 20,000 to 35,00; thus very significant. What are the actual numbers orpercentages it increased from and to?9.The first few sentence of the section "women's health in the middle of life" are very awkwardand hard to follow. Then you jump to important coping mechanisms but don't elaborate those,which would be relevant.10.A number of times, you leave a space before the periods, please remove those.11.Page 6, the second paragraph is very awkwardly written.12.Line 20: which women are more likely to be affects? Based on what you say in the paragraphabove, it is affected by mental health, social relations, income, working conditions, and critical lifeevents. Anything it is not related to? And how are those related? More social relation, better
health? Higher income, better health? I'm not questioning that these are not all related and I agree
that it is important to study those relationships, but clearly others have written about this in the
past and it's important you tease out more clearly and with a better structure for the reader whatthose known relationships are.13.Overall, you could also update a number of your references to include more current studies.14.Line 27: are an important part, not is; and are essential15.Line 32: What are the confidence levels?16.Line 37: missing reference17.Line 55: what are various forms? Please be more specific18.Next page line 14: what is "future mortality"? do you mean mortality?
19.Line 24: unclear long sentence, maybe because of missing commas, but what are you trying to
say. This paragraph is missing an intro sentence what it is about. If these other studies ahd a longertimeframe, was it because they had a different definition for middle aged? Why would you makedifferent choices? Your choices might be very valid and useful but you need to spell them out.
Methods
20.All patients "were" previously..21.Make a comma after trial and start a new sentence in line 1322.Line 40: just to be clear, inclusion criteria was female gender, not female sex? So you mighthave men identifying as women included in the study?23.Page 9: please describe briefly why you chose specifically those questionnaires and what eachof them intends to study. Do you have any measures of validity and reliability for them that youcan include? If not, please explain.24.I see that you outline these questionnaires in detail on the next page. This should all gotogether. Please restructure25.Page 11, line 24: add a comma after subscales26.Line 26: "being better than average" is a very odd choice of wording. Please change
Results
27.Line 27: add comma after expected28.The results section is very well written and constructedDiscussion:29.Line 11: good health, not a good health30.The first sentence is quite awkward.31.You need to think about and include more than one limitation. Every study has a number oflimitations, and you are asked to consider and describe the most important ones. What about itbeing a cohort study, how could that have been a limitation? Or having a set of questionnaires onlyincluded at the end. Are there any other confounding factors that could play a role? Small numberof women in each round of data collection?32.What does your research add that wasn't known before? What about your use of the differenttypes of role functioning, which sound to me like very gendered variables allowing for a gender-based analysis. You didn't really describe them in detail, maybe those could give your study a bitmore of an edge.
Table 3a
33.Did you really include depression ad a predictor variable for the model assessing mental
health? That needs to be excluded.
34.Same with including work ability as a predictor for work ability. That's a very odd choice.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
NoAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
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