JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Extensive lesions and a positive cone margin are strong predictors of residual disease in
subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3
Study design Retrospective study
Version: 1 Date: 15 Jun 2023
Reviewer's report:
I read with great interest the paper by Hongfa Peng and colleagues.
They report the rate of residual disease in hysterectomy of women previously treated with
cervical conization for CIN2/3, analyzing the risk factors for residual disease.
Unfortunately, reading the paper some major concerns emerged.
- In the methods section it is not specified if CKC and LEEP were “colposcopy-guided”. The
colposcopy-guided excisions are the standard of care for women with CIN2/3 and surgical
excision without colposcopy should be discouraged. A 24% rate of positive ectocervical
margin after conization seems to be too high and probably reflects the use of excision without
colposcopy assistance. Authors should clarify this point.
- The Authors aimed to find “a more accurate predictor of residual lesions after conization”. Did
they consider the opportunity of a 6-months follow up with cervical cytology and colposcopy
(as suggested by several international guidelines)?
- Why only women with hysterectomy performed within 7 months have been included?
- It is not clear why the 267 patients recruited underwent hysterectomy after cervical conization.
Cervical conization is a worldwide accepted standard of care for CIN2/3 and there is no evidence
to propose hysterectomy in these patents. Moreover, it is widely demonstrated that hysterectomy
for HPV-related cervical disease is the most important risk factor for developing vaginal
dysplasia and invasive vaginal cancer. Therefore, the chose of hysterectomy after CIN2/3 should
be carefully evaluated and considered only in selected cases (e.g: AIS or microinvasive cervical
cancers or those cases in which a colposcopic follow up is impossible).
- 45 included patients were 20-39 years old. It is absolutely a clinical nonsense to propose a
demolitive surgical approach in such patients only for CIN2/3 diagnosis. The authors should
discuss extensively why they choose this management.
Title: Extensive lesions and a positive cone margin are strong predictors of residual disease in
subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3
Study design Retrospective study
Version: 1 Date: 16 Jun 2023
Reviewer's report:
Residual disease in women undergoing conization for CIN2-3 may only be relevant if there is
residual invasive disease. Indeed, the presence of positive margins in conizations for CIN2-3 is
not mandatory for a repeat conization, let alone a hysterectomy.
Authors should detail cases of invasive squamous or in-situ/glandular invasive disease at
hysterectomy and categorize the sample accordingly. Stating that the presence of preinvasive
residual disease (CIN2-3) may be an indication for repeated conization or hysterectomy contrasts
with what is reported by current international guidelines.
Calculation of sample size should be performed.
Why was HPV status not included as an independent variable?
Given the topic, the following papers should be included: PMID: 31812841; PMID: 35474511;
PMID: 37296839 (relating to glandular recurrences and type of treatment).
Title: Association of physical activity with psychological distress and happiness in mothers of
children with autism spectrum disorders during the COVID-19 pandemic
Version: 0 Date: 24 Jun 2023
Reviewer's report:
Thank you for inviting me to review this interesting paper. The paper is very well-written and
adds valuable knowledge. I only have some minor comments for the authors’ consideration.
Line 39 – MPA was classified into three categories. Suggest rephrasing “#149” as it reads like
a binary word opposite to “#150”.
Line 55 - Grammar check should be done throughout the main text. “increase” should be
“increased”, and “on” before “specifically” should be deleted.
Line 136 – Walking is generally considered a kind of light-intensity physical activity. Please
give reasons for including walking as MPA.
Title: Association of physical activity with psychological distress and happiness in mothers of
children with autism spectrum disorders during the COVID-19 pandemic
Version: 0 Date: 26 Jun 2023
Reviewer's report:
This study investigated the association among PA, psychological distress, and happiness in
mothers of children with ASD during the COVID-19 pandemic. I think this is a timely and
current topic, and also trust this study is important to the scientific community. Although a very
well-written study, I have some points I think can be better explained. (1) The introduction
section is too simple and too brief. This study focuses on mothers of children with ASD, and
it is necessary to explain the reason of choosing this group, what distinguishes their levels
of PA, psychological distress, and happiness from other populations, and what significance
the study results have for this group. However, similar questions have not been addressed.
It is recommended to add more content to the introduction section. (2) From the Methods,
it can be seen that the study was only conducted in two prefectures in Japan. This may
result in regional characteristics of the study, which should be supplemented in the limitations
section if applicable. (3) It can be seen that the controlled variable only took the number of
children with ASD as the controlled variable. Would the severity of ASD in children have an
impact on the results? If not, please supplement the literature in the appropriate place. (4) The
explanation for the lack of association between PA and psychological distress in the Discussion
section is insufficient, with limited content and no supporting evidence from other studies.
It is recommended to add more information to address this issue. (5) The issue raised in the
Discussion section is similar to that in the Introduction. Since ASD mothers were chosen as
the study population, the study should demonstrate their uniqueness. However, the Discussion
section did not convey the distinction between this study and studies involving the general
population.
Title: Gender Differences in the Acceptance of Wife-Beating: Evidence from 30 countries in
Sub-Saharan Africa
Version: 0 Date: 24 Apr 2023
Reviewer:  Samuel Nhanag
Reviewer's report:
Problematic
The subject analyzed in the present paper is an interesting topic. In Africa, the gender
consideration is progressive but it is important we found also enough unwillingness. In addition,
the topic compared this situation among the sub-Saharan countries.
Literature and theory
The author must do a deep analysis of literature and the theory of the subject. This analysis is
very important and can help the authors to be specific. For example, the authors must be able
to identify a large set of acceptance of wife beating determinants from the literature and theory
review. It after that exercise that the author can justify to use one or another determinant Durant
the specification of the model.
Methodology
Globally, the study methodology has specific and important information that allow to understand
the process of data collection and data analysis. Nevertheless, others consideration need to be
take in consideration. For example the reference period of data used.
More of that, it is important to justify (during the specification of the model) the choice of
independent variables. Why this variables and not others? If the literature review oriented this
choice, it is important to mention it. Otherwise, in order to be smart in the analysis process, the
authors could implement Multiple Component Analysis (ACM) to identify potential variables
that explain the dependent one.
Compared to the logic regression, several reasons could justify the utilization of the multilevel
analysis.
Results
The results are clear
General consideration
We consider this paper as a very original one because it try to compare a specify situation among
several comparable countries. The data used comes from DHS. The methodology used for the
data collection is approved in international level. The data coming from this survey have high-
level quality. In addition, the model used is good. Nevertheless, some considerations could help
the authors to be most SMART.
The paper can be published.
NHANAG SAMUEL
Title: Gender Differences in the Acceptance of Wife-Beating: Evidence from 30 countries in
Sub-Saharan Africa
Version: 0 Date: 01 May 2023
Reviewer's report:
Overall, the paper is well-written, and the authors have provided a clear rationale for their study.
Understanding gender differences in the acceptance of wife-beating helps to develop appropriate
and targeted policies and interventions. The literature review is quite concise and highlights
the various factors that influence IPV and wife beating. However, it could also do with a short
paragraph on the effects of wife beating as found in literature such as on the woman’s health,
her child’s health, employability, and psychological effects.
It would also be beneficial to include a more detailed section on specific policy and program
recommendations. For example, although a higher age is associated with decreased acceptance
of wife beating, that actually points out the need for intervention and desensitization targeted at
younger populations. Again, if exposure to mass media is associated with decreased acceptance
of wife beating, then mass media and social media campaigns should be a recommendation.
The paper can also highlight successful interventions to reduce IPV particularly those that have
used a “gender dialogue groups” approach (see Gupta, J., Falb, K.L., Lehmann, H. et al. 2013
doi: 10.1186/1472-698X-13-46)
Overall, the paper is original enough to warrant publication. The paper adds to the body of
work on the gender norms that perpetuate violence against women. I recommend the paper for
publication.
Additional comments:
Sentences 1 and 2 of the background section should be combined into 1 sentence.
There is an error in this sentence found in the discussion section – “It is however worth noting
that the present study showed that given the same level of education, women are more likely to
accept wife beating as compared to women.”
Title: Factors Associated with Mental Health of Internal Migrants (Kayayei) in Agbogbloshie-
Ghana
Version: 5 Date: 18 Jun 2023
Reviewer's report:
This is a second round review. I note there have been minor improvements to the manuscript
as earlier comments were addressed but not completely. The methods section of the manuscript
still has areas that need clarity. Generally, there is lack of clarity in data analysis especially the
implementation of binary logistic regression analysis. The current exposition is inadequate. How
were the models built? Variables in lines 163-166 are not dependent variables but independent
ones. The variables in lines 167-187 should be the dependent variables. However, there is no
elaboration on how these variables were converted to binary form.
On ethical clearance, it is evident that there was none done in Ghana.
For interviews conducted in local languages, were the questionnaires translated into these
languages from English or on spot translation was done? If on spot translation was done, how
was uniformity or consistency in asking questions guaranteed by different interviewers?
Title: Determinants of contraceptive continuation among women in sub-Saharan Africa
Version: 1 Date: 06 Oct 2022
Reviewer's report:
General Comment
Thanks to the authors for addressing this issue in SSA. Research into the motivations for
continued use of contraceptive methods is indeed crucial to achieving fertility reduction in this
region.
Policy implications section
It would be relevant to mention the following in this section :
The authors talked about the fear of side effects, but there are
indeed several side effects that cause many women to abandon
contraception as identified by Leah A. Schrumpf et al for example, in
their study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082910/#:~:text=Side%20effects
%20include%20menstrual%20changes,complications%20%5B8%2C%209%5D).
It is necessary for the decision makers to investigate more on this and to take it into account
effectively.
Likewise, in SSA, there is not a wide range of choices regarding methods for women, but also,
the costs of some methods are not affordable for all. Unfortunately, free contraception is limited
to only a few methods.
References
I think there are mix-ups between the references, e.g. the [35] as mentioned in the discussion
section is a study from Uganda and not from Ghana.
“The odds of contraceptive continuation were lower among those residing in rural areas as
compared to those residing in urban areas. This is consistent with the findings of a study
conducted in Ghana [35].”
The Ghana study was not conducted by the same authors from Uganda.
Title: Changes in relationships, HIV risk, and feelings towards PrEP: findings from a qualitative
explanatory study among participants in the CHARISMA intervention trial
Version: 3 Date: 12 Jun 2023
Reviewer's report:
This paper exploring the reasons for the null results in CHARISMA is a valuable contribution to
understanding counseling-based interventions and  the relationship change dynamics in young
women from South Africa.
My minor comments are only based on edits in sentences that need to be relooked for clarity.
These are on: pg.4 lines 5-6; pg.6 lines 4-7
Title: Investigating the Association between Educational Attainment and Allostatic Load with
Risk of Cancer Mortality among African American Women
Version: 1 Date: 11 Apr 2023
Reviewer's report:
BMC W H
4/11/23
Rev
A secondary analysis of NHANES follow-up related cancer death to AL and education in AA
women. But conclusions are not supported by data presented.
Please number pages.
Strengths: interesting topic
Weaknesses: questionable methods and analyses, many exposure categories and stratified
analyses with few endpoints in many and hence very wide CI.
Intro
Please reduce repetition.
Meth
A more detailed description of how data from NHANES III (1988-1994) and continuous
NHANES (1999-2010) is needed especially exactly how the appropriate survey weights were
created from the 6 weights for the 6 files.
State whether those with history of cancer were excluded from survival analysis.
The distinction between exposure, confounders, effect modifiers and mediators may be faulty.
Results
Please omit anything on cancer subtypes, eg obesity-related.
Disc
Please shorten and rewrite to omit discussion of findings for which the analysis lacks statistical
power. Eg education is not protective.
Limitations should highlight lack of precision with wide CI in survival analysis and need for a
study in  much larger sample.
Title: Investigating the Association between Educational Attainment and Allostatic Load with
Risk of Cancer Mortality among African American Women
Version: 1 Date: 24 Apr 2023
Reviewer's report:
This excellent paper is to examine the relationship between educational attainment levels and
allostatic load in AA women and their association with long-term risk of cancer mortality
using nationally representative data, NHANES. Research aim is clear and specific and analytic
methods are straightforward and proper. In the following, I have some questions/comments by
line numbers.
Ll 54 – 56: “We completed analyses using domain statements  to account for appropriate
estimations of covariance-variance structures using specific strata, cluster, and weighting
procedures as specified by NHANES methodology.” =# “domain statements” is software-
specific term. Please elaborate why you didn’t use “By” statements for the analysis. And cite
relevant material.
L 65: Independent Variable and Other Variables of Interest. =# For example, educational
attainment was measured at the time of interview? Any chance of additional attainment in-
between? Alluded in limitation section, could be specifically mentioned that this could be time-
varying covariate in the limitation section?
Ll 122 -124: : “Primary analyses were conducted using NHANES-generated sampling statistical
strata, clusters, and weights  as designated and described in detail within the NHANES
methodology handbook.” =# You used NHANES 1988 – 2010 files. It is unclear how did you
create a single analytic file by combining separate NHANES files. In particular, how did you
develop “weights” for the 1988 – 2010 file? Does the “weights” reflect the eligible population
at a mid-point between 1988 and 2010,  Or,… ?
Ll 144 – 145: “All statistical analyses were performed using SAS” =# Be specific. List used
SAS procedures since you have considered sampling design parameters (Strata, clusters, and
weights). Have you considered the sampling design parameters for the Kaplan-Meier survival
estimator and the proportionality assumption tests too?
Title: The Effect of Date Fruit Consumption on Early Postpartum Hemorrhage: A Randomized
Clinical Trial
Version: 1 Date: 06 Mar 2023
Reviewer's report:
Dear authors, my compliments with your paper "The Effect of Date Fruit Consumption on Early
Postpartum Hemorrhage: A Randomized Clinical Trial".
This is a generally a well written paper. The rationale for the study is well laid out and the study
designed seems logical.
The results are consistent with the objectives and the discussion was satisfactory. I liked that
you put the limitations, but I missed a paragraph that talks about the merits of their work.
Title: The Effect of Date Fruit Consumption on Early Postpartum Hemorrhage: A Randomized
Clinical Trial
Version: 1 Date: 06 May 2023
Reviewer's report:
1- Select keywords from MESH (http://www.nlm.nih.gov/mesh/MBrowser.html).
2- 2-Give explanations about the reliability and validity of the Pictorial Blood Loss Assessment
Chart (PBLAC) and describe the numerical values of Cronbach's alpha.
3- Why the amount of postpartum hemorrhage was compared using the Mann-Whitney U test?
4-  Report the result of the Shapiro-Wilk, Kolmogorov-Smirnov table.
5- As the eligible subjects were divided into the date and control groups using the block
randomization method; therefore; remove the p-value in Table 1 and delete this sentence: There
was no statistically significant difference between the two groups in terms of all individual
characteristics and fertility and both groups were homogeneous.
6- In the study design was reported that samples were to be included in the intention-to-treat
(ITT) analysis. Authors need to knowledge that the intention-to-treat (ITT) analysis refers to
analysis based on the initial treatment assignment, and not on the treatment eventually received,
where all participants who are randomized are included in the statistical analysis and analyzed
according to the group they were originally assigned, regardless of what treatment (if any)
they received, therefore in present study data analysis was not done on the initial treatment
assignment.
7- How much time did last the study?
8- Write References for the last 10 years. References below 2013 should be deleted.
Title: Evaluation of psychological distress are essential for patients with locally advanced breast
cancer prior to neoadjuvant chemotherapy: baseline findings from cohort study
Version: 2 Date: 11 Jul 2023
Reviewer:  Janghee Lee
Reviewer's report:
Your research is about the psychological distress in locally advanced breast cancer patients
receiving neoadjuvant chemotherapy. I have a few questions and additional advice about your
study.
1. The current title does not seem appropriate for this research. Because you have conducted
an investigation into psychological distress in LABC patients rather than implementing
psychological therapeutic interventions and demonstrating improved outcomes. Therefore,
therapeutic interventions are speculated as one of the possible approaches to overcome the
current issue. Using such speculation as the title of the paper would not be appropriate.
2. The timing of HADS (Hospital Anxiety and Depression Scale) measurement should be
clarified in the "Method" section of the paper. Did you administer the HADS questionnaire
before starting NACT, or did you also measure it during the course of NACT? Providing
this information will be helpful for readers to understand when the psychological distress was
assessed in relation to the treatment timeline.
3. The main finding of the research is that anxiety, depression, and psychological distress are
high among LABC patients, and they are correlated with clinical features such as age, insurance,
and LN (lymph node) status. Therefore, it seems that the results from Additional File 2 are one
of the crucial findings. Placing Additional File 2 as the main table would be beneficial.
Title: Evaluation of psychological distress are essential for patients with locally advanced breast
cancer prior to neoadjuvant chemotherapy: baseline findings from cohort study
Version: 2 Date: 13 Jul 2023
Reviewer's report:
The authors conducted this study to better understand the relationship between social and clinical
factors related to stress, depression, and anxiety in breast cancer patients from the time of
diagnosis to the start of neoadjuvant chemotherapy. However, it is difficult to see how the
findings of this study differ significantly from those of previous studies. Several studies have
already shown that advanced stage patients with axillary lymph node metastasis, low-income
patients, and patients with a prior medical history have a high level of mental distress.
Abstract say it's from 2021 to 2022, but in the 'Methods' section of the manuscript, it says patients
were recruited from 2020 to 2022, so a clear entry is required. Also in abstract, ‘The prevalence
of depression, anxiety and psychological distress among was 59.6% (95% CI: 52.6%-66.3%),
47.8% (95% CI: 41.0%-54.8%), and 65.07 % (95% CI: 58.19%-71.52%) respectively.' some
words were missing after among. Futhermore, it was written as Her2 in the breast cancer
subtype, which is generally written as HER2. When describing the %, it would be nice to use it
consistently, whether entering only one decimal point or both decimal points.