Reviewer ’s report  
 
Title:  Referral gynecological ambulatory clinic: Principal diagnosis and distribution in health 
services  
 
Version: 1 Date: 23 Aug 2017 
 
Reviewer:  Themistoklis  Mikos  
 
Reviewer’s  report:  
 
This study attempts to describe the incidence and the initial management of the gynecologic 
conditions that are seen in a secondary setting in an urban area in Brazil. This kind of studies is 
particularly useful in the strategic design of the management of  the gynecologic conditions in the 
level of a geographic area or even in the level of a state. The appropriate design of the study and 
the degree of the generalisability of the results are very important factors. Unfortunately, neither 
the design, nor the population of this study offer a chance for easy extrapolation of the study 
results; the design is retrospective and the study population is small and does not appear to cover 
multiple class, income, education, and professional groups.  
 
Overall the manuscript demands extended linguistic editting in English.  
 
1. Study design  
 
This study has apparently a retrospective design. I would suggest the authors clearly state it in 
this section. If this study was a part of an audit, I would suggest that the authors state this as well, 
describing the reasons that the audit was conducted and the objectives it might have.  
 
2. Sampling  
 
Where the authors based their decision to use the 44.5% of the population proportion as 
significant figure for the study  sampling?  
 
3. Data source  
 
For not Brazilian readers, it is very difficult to understand what WHACUH -USP is. I would 
recommend a short description of the levels of health services in Brazil and their basic 
interconnections. By this means, the average reade r will be able to communicate the basic 
concept and the results of the study.  
 
Another very important factor that needs to be described is the population that is mainly served 
by WHACUH -USP: rich -poor, urban -rural worker, high class -low class, etc.  
 
What abo ut the seasonal incidence of the gynecological diseases in the study population?  
 
4. Discussion: Page 10, Line 26  
 
This paragraph needs expansion. The authors should describe the findings of similar studies from 
Brazil and abroad and comment on the similari ties and the differences.  
 
5. Discussion: Page 10, Line 36 until Page 11, Line 28.  
 
These paragraphs do not add anything to the manuscript. There is a desciption of the 
gynecological diseases and some potential complications of them. Please omit; this is ge neral 
medical knowledge, minimally related to the objective of the study.  
 
6. Discussion: Page 11, Line 32  
 
This is a statement that does not derive from the results of the study. Please omit or rephrase.  
 
7. Discussion: Page 11, Line 39  
 
This is a statement  that does not derive from the results of the study. In fact, this is an 
extrapolation from other studies that we do not know if it is proven or not. Please omit or 
rephrase.  
 
8. Discussion: Page 12, Line 8.  
 
Please point out where are the results of the s tudy that highlight the gaps in health care. It 
appears that this is something beyond the aims of the study.  
 
9. Discussion: Page 12, Line 25  
 
In this paragraph, the authors point out the population diversity that need to be met when 
designing studies of this type. See also point #3.  
 
10. Conclusion  
 
The first sentence is confusing, please omit.  
 
11. Table 1.  
 
Smoking: 20.6% + 79.9% = 100.5%. Plea se correct the percentages.  
 
Coitarche: 10.1% + 69.9% + 19.9%= 99.9%, Please round the figures up to 100%.  
 
Menarche: 44.1% + 50.3% + 6.1%=100.5%. Please correct the percentages.  
 
12. Table 2.  
 
Please change ','  with "." in the p column.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are 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 further 
assessment in yo ur comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation  that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation  that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fee s, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be include d in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal