Reviewer's report
Title:Predictors of severe pelvic inflammatory disease in remote North
Queensland Indigenous communities, 1997-2005
Version:1Date:9 December 2014
Reviewer: Jacqueline Boyle
Reviewer's report:
Review of Paper for BMC women’s health
Ling M and McDermott R. Predictors of severe pelvic inflammatory disease in
remote North Queensland in Indigenous communities, 1997-2005
This is an interesting paper with a unique opportunity to describe linked data for a
significant health issue in North Queensland despite the limitations of the cross
sectional nature of the data.
I think however the paper would benefit from some significant revision and
questions to be addressed in particular the age group of the cohort assessed
(see 2. below)
1. The question posed by the authors is
To understand the behavioural and other baseline predictors of severe pelvic
inflammatory disease (PID) in a high risk population in remote northern
Australian Indigenous communities indicated by hospitalization over the
subsequent 7 years for PID.
Line 84 actually refers to “young women” which is incorrect as the age group is
15-89.
I think it should be stated that severe PID is indicated by hospitalisation in the
abstract also
2. Are the methods appropriate and well described
The methods are well described in terms of how the data was collected but I
don’t think are appropriate. STIs and PID are known to be highest in young
women and particularly women of reproductive age. STIs have been increasing
in older women newly single in the general Australian population but I dont think
it is useful or clinically appropriate to include the women of all ages particularly
given the wide confidence intervals and potential differences of postmenopausal
and pre-menopausal women.
It is not very clear in the tables or methods why the data are presented as they
are and this should be made clear but I think the following has been done:
Table 1.0 The only way to know if someone from the original cohort developed
PID is if they were hospitalised. Is the purpose of the comparison of the
hospitalised to non-hospitalised women to see if the hospitalised cohort is
representative of the original cohort ?
Table 2 Compares those with PID to those without, whether hospitalised for other
reasons or not hospitalised at all. This needs to be clear in the labelling of the
table. The table gives an indication of possible differences between the two
groups that should be taken into account in the regression analysis.
It would perhaps be useful in Table 2 to see the variables presented the same
way as in Table 3 e.g. age and RCF as categorical variables rather than
continuous, so that we can see where the differences were in ages and RCF and
if there looked like different patterns at different categories (e.g. effect
modification).
Table 3.0 univariable analysis hasn't been presented for BMI, BP,
cholesterol/LDL and ACR despite significant differences between the two groups.
Statistically, it would be useful to see the crude ORs for associations between
these and PID although a clinical justification for not having done this for some of
these is reasonable but needs to be stated.
It is also not clear which is the age group used as the reference in the
multivariate models.
Depending on what was crudely associated with PID it would fit with the key
message of the article to do one multivariable model instead of two and it would
have included: age (using fewer categories), RCF (using fewer categories),
smoking, chlamydia/gonorrhea combined, and any of BMI, BP, cholesterol/LDL
and ACR if clinically relevant. There does not appear to be a clear value of
presenting an age adjusted model and then a full model in this instance
particularly with older women included.
There is a reference to hazard ratios in the discussion which is not correct as
logistic regression has been undertaken with odds ratios reported.
Glucose levels are described but is there any difference in diabetes between the
groups?
3. General comment
It is important to state somewhere that Indigenous refers to the two Indigenous
populations of Australia (Aboriginal and Torres Strait Islander)
4. Writing and grammar
There are numerous spelling mistakes and grammatical errors. Some I have
listed below but care should be taken to read the manuscript carefully and edit
appropriately
Line 23 – Indigenous women in remote North Queensland had higher prevalence
of
24 overweight and obesity,…….”had” should read “have”
Line 31 Torren should be Torres
Line 65-68 Despite the fact that PID is preventable and treatable with early
diagnosis and effective management of sexually transmitted infections (STI), it is
associated with long-term morbidities including infertility, chronic pelvic pain, and
ectopic pregnancy [2, 3],
The above sentence doesn’t make sense. Yes PID is associated with these
complications but can be prevented if treated early – perhaps reverse these two
parts of the sentence
Line 90 Briefly, All residents
Should be a not A
Line 141 match unit record, facility code tuples were extracted.
Need to explain what are “tuples”
5. Limitations
Limitations are mostly well discussed
6. Discussion and conclusions
The discussion and conclusion refers to inadequate fruit and vegetable intake yet
there is no significant difference between the groups so this is based on RCF
which should also be discussed. Eg. the limitations of self reported fruit and
vegetable intake.