JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Risk factors of human papillomavirus-related cervical lesions in postmenopausal women:
a cross-sectional study
Version: 0 Date: 06 Feb 2025
Reviewer:  Morvarid Noormohammadi
Reviewer's report:
The manuscript is well-written, with a clear structure, however, minor grammatical corrections
are needed to improve fluency and readability.
Slight restructuring is needed for better logical flow, especially in the Background section.
A bit more precision in phrasing, particularly regarding HPV prevalence and screening
challenges is needed.
The discussion could better emphasize the clinical implications of the findings, particularly for
screening strategies.
The limitations section could be expanded by discussing potential biases in data collection and
the retrospective design.
Section by section
Abstract
The Abstract's background states that cervical cancer incidence is increasing, in whom?
The Abstract's results could explicitly mention the adjusted odds ratios (aOR).
The conclusion should highlight the clinical application of these findings.
Introduction
The first paragraph of the introduction provides information on the epidemiology of cervical
cancer and HPV, especially in less developed countries. Please also include information about
China and the region where you conducted the study.
The paragraph on screening challenges in postmenopausal women in introduction is strong but
could benefit from an explanation of how screening guidelines differ for younger vs. older
women.
Methods
• The HPV DNA testing methodology could be more detailed—what were the quality control
measures?
• The logistic regression model should clarify which covariates were adjusted for in the final
model.
Results
• Tables are well-organized, but it would be helpful to bold statistically significant results in
tables for clarity.
• The description of TZ3 could include more details on why it is associated with higher risk.
Discussion
• The discussion correctly highlights the importance of HPV types 16/18 but could compare
findings with other regions or studies.
• The colposcopy findings are significant; consider discussing how clinician expertise might
affect diagnostic accuracy.
• The limitations could mention selection bias, as only women who participated in screening
were included.
Conclusion
• The conclusion should be more action-oriented, suggesting specific screening
recommendations based on findings.
Title: Risk factors of human papillomavirus-related cervical lesions in postmenopausal women:
a cross-sectional study
Version: 0 Date: 11 Feb 2025
Reviewer's report:
Shorten the introduction, and better explain the rationale and purpose of the study.
In the methods, define the inclusion and exclusion criteria. Is the histology data on cervical
biopsy or on conization? If only on cervical biopsy, you should report the number of biopsies
performed.
What were the criteria for including the independent variables in the multivariate analysis after
performing the univariate analysis?
Can you provide a sample size calculation based on the primary objective of the study.
What do you mean by LSIL lesions? CIN1? The same goes for HSIL lesions. Do you mean
CIN2+, CIN3 lesions? Please specify.
Given the topic, I would add the following papers to the discussion: PMID: 33795132; PMID:
25603323.
Title: Risk factors of human papillomavirus-related cervical lesions in postmenopausal women:
a cross-sectional study
Version: 1 Date: 15 Mar 2025
Reviewer:  Morvarid Noormohammadi
Reviewer's report:
The authors have addressed all my concerns effectively.  The revised manuscript is significantly
improved.  The presented research is now clear and compelling.  I believe this work is suitable
for publication in its current form.  I recommend acceptance.
Title: Real-World Breast Cancer Treatment Patterns and Guideline-Concordant Treatment
Completion Among Malawian Women
Version: 0 Date: 24 Nov 2024
Reviewer's report:
Dear authors,
The manuscript is well-structured, methodologically rigorous, and addresses a critical gap in
understanding the implementation of resource-stratified breast cancer guidelines in Malawi.
The focus on guideline-concordant treatment (GCT) and its association with improved survival
is particularly relevant, as it underscores the importance of comprehensive care pathways in
improving outcomes for women with breast cancer in sub-Saharan Africa.
Here are some areas for improvement that I believe will enhance the impact and clarity of your
work:
a) Provide a clearer explanation of key definitions, such as "curative-intent guideline-concordant
treatment (GCT)" and its thresholds, early in the text.
Offer more detail on how incomplete staging data were handled and their potential impact on
the study's findings.
b) Explore the reasons for low endocrine therapy initiation and the lack of HER2-targeted
therapies in greater depth. These are critical barriers to care that warrant further discussion.
c)Expand on the implications of HIV status on treatment completion, considering the
intersection of stigma, comorbidities, and systemic barriers.
d)The limitations section is adequately detailed but could emphasize how ongoing efforts (e.g.,
electronic data collection tools) will address current challenges.
e)Consider providing more actionable recommendations, such as task-shifting to non-physician
providers or community health workers to improve GCT completion rates.
Title: Real-World Breast Cancer Treatment Patterns and Guideline-Concordant Treatment
Completion Among Malawian Women
Version: 0 Date: 25 Nov 2024
Reviewer:  Eduardo Camargo Millen
Reviewer's report:
This is an important paper that claims to imperative meausres to improve breast cancer care in
low incomes countries.
The metodology used is adequated, and is ready to be published
Title: Real-World Breast Cancer Treatment Patterns and Guideline-Concordant Treatment
Completion Among Malawian Women
Version: 0 Date: 08 Feb 2025
Reviewer's report:
Dear authors,
Congratulations on your work and this manuscript. You report on an issue which is a significant
concern in low resource settings.
Please find below a few comments to consider in revising your manuscript.
1. Results – please consider including references of tables in which some stated results can be
found in the results writeup to help sign post readers. For e.g. “Among all patients treated with
curative-intent, alternative initial chemotherapy regimens outside of an anthracycline or taxane
were more frequently received (51%) in patients with stage III compared to stage II disease
(8%).” Please are these reported in any of the tables?
2. In section under survival - “OS for patients with stage II disease was not reached (95% CI
24.5-)” CI is incomplete please.
3. Please check all that is reported in text in results and discussion sections regarding this
work tally with what is presented in the Figure and Tables. For example there are a couple of
statements that do not concur with what is reported in Figure 1. E.g.
a. Page 11 section on curative intent treatment - ‘Of the 65 patients with non-metastatic breast
cancer recommended to initiate a curative-intent treatment pathway, 41 (63%) completed GCT.’
b. Discussion - “The majority (72%) of non-metastatic patients received NAC” - please this does
not correspond with numbers in Fig 1 47/67 = 70%??
c. Discussion - “Most of our patients did not meet criteria for GCT completion because they
did not undergo breast surgery” - please how does this relate to Fig 1 where 42 patients in all
had mastectomy?
4. Discussion - “Most patients in our cohort presented with non-metastatic breast cancer and
received curative-intent treatment with a low proportion of guideline-concordant treatment
completion” - GCT is stated as 63% in your results. Please is this what you are referring to as
low?
Title: Incidence of loss to follow-up and associated factors among mothers on antiretroviral
therapy in the context of elimination of mother-to-child transmission of HIV in two health
districts of Bobo-Dioulasso in Burkina Faso
Version: 4 Date: 12 Sep 2024
Reviewer's report:
This is a well written manuscript which was interesting to read.
Some suggestions:
Abstract- it is not clear where these WLHIV are recruited from, nor if they are pregnant at
screening.
Results: It would be helpful to include person-years of follow-up and # of events of LTFU.
Was age a continuous or categorical variable? and education was not associated with LTFU?
Background
This provides a good rationale but should include more on importance of viral load suppression
and the mechanisms by which art reduces vertical transmission. Suggest more on reasons for
ltfu during pregnancy/breastfeeding from similar contexts, including in women in general, to
allow comparison with available data for the construction of variables, and the results from BF.
Are we missing data on some key potential drivers of LTFU?
Methods
A map could be interesting for the setting and location of clinics, if available.
The same comment as above in terms of pregnancy status of wlhiv at time of screening.
How were the dates for data inclusion determined?
For the marital status variable, why was it defined as couple, non-couple, rather than the
traditional married, living together, etc?
For the definition of LTFU, is it possible that the women are accessing art through another
facility without it being recorded under her unique ID? Is the database national or district
specific? How mobile is the population, and is that variable part of the database?
Results
Would link to figure 1 after the total number of included women (line 124).
How many person years were observed? Suggest moving the information on p.8 lines 140-142
to the first section.
Can you compare the demographics of the sampled population to other sources? For instance,
what is the median fertility among women in BF and in WLHIV in BF? And to repeat my prior
comment, as this is part of eMTCT, what is the pregnancy status of the sample? If some or all
are pregnant, at what stage of pregnancy were they screened for HIV?
I am surprised that the level of education has a p-value of 0.5 as there seems to be a reasonably
large difference between none vs primary or secondary. Did they consider generating a binary
variable of none vs any education?
Further details on who would be included in not in couple would be useful- are they divorced,
widowed or never married? If the former, this would mean that they were likely to be older than
the other group, which might confound the relationship between marital status and ltfu.
Table 2 still contains some French language.
Discussion
Line 166- how does the high incidence of ltfu support that women are adhering to the strategy?
I see that you note lack of traceability as a limitation. Please see comment above which could
be addressed here.
A discussion on viral load testing could also enrich the discussion.
Title: Incidence of loss to follow-up and associated factors among mothers on antiretroviral
therapy in the context of elimination of mother-to-child transmission of HIV in two health
districts of Bobo-Dioulasso in Burkina Faso
Version: 6 Date: 22 Oct 2024
Reviewer's report:
Thanks to the authors, they provided a detailed rebuttal letter and answered most reviewers’
comments.
I still have a few minor comments that could be easily fixed before publication.
In their response, the authors stated that “Mothers who were transferred or died before the end of
the follow-up were excluded because they could not be considered lost to follow-up or regularly
followed up”. This is exactly the purpose of a right census. In that case, these women should
simply be right-censored at the time of death or transfer. According to Figure 1, only 8 women
died or were transferred. So it will not change the results. But technically, it would have been
cleaner to include them and to censor them.
My comment about the “Number of children” was probably unclear and has been misunderstood.
When is this information collected, and how is it calculated? If women were asked during
pregnancy, technically, the pregnancy should not be taken into account. Then, you should
have women with zero previous children (i.e. excluding the current pregnancy). Here, women
are categorized as “one” or “two +” (to be noted, it is better to use “#2” than “>1” to avoid
confusion). So I guess that the current pregnancy is considered (+1), or the variable was
measured after delivery. If this is the first pregnancy of a woman, and if she delivered twins,
in which group is this woman considered? A simple sentence to clarify the indicator would be
welcomed.
Page 6. “Bivariate analysis was used to identify factors associated with loss to follow-up.”
Describe the bivariate analysis considered here. Did you mean univariable Cox models?
Regarding the results (abstract and manuscript) in terms of factors, it is uncommon to present
Kaplan-Meier (bivariate analysis) after multivariable Cox models. The authors could consider
reversing the order.
Table II. “univariable and multivariable analysis (Cox models)” instead of “bivariate and
multivariate analysis”.
Figure 2: the resolution of the figure is low in the provided file. A version with more resolution
would be welcome. If the journal allows it, please consider a coloured figure to improve
readability.
Title: Sequential Therapy of Dienogest Following Relugolix for Adenomyosis and Impact on
Symptoms and Serum CA125 Levels: A Case Series
Version: 4 Date: 20 Feb 2025
Reviewer's report:
Dear Authors,
I read your manuscript with great interest.
the possibility of using new medical therapies is always appreciable. To improve the article I
suggest:
- in your manuscript you talk not only about adenomyosis but also about endometriosis
- discuss the impact of therapy on the most suggestive symptoms of adenomyosis, such as
dysmenorrhea and AUB
-discuss the advantages of GnRH antagonist compared to agonist
-discuss the impact of GnRH analogue on bone density after 6 months of therapy
-discuss the impact on adenomyosis in terms of size and grade
-update the bibliography with more recent articles
Sincerely
Title: Sequential Therapy of Dienogest Following Relugolix for Adenomyosis and Impact on
Symptoms and Serum CA125 Levels: A Case Series
Version: 4 Date: 25 Feb 2025
Reviewer's report:
The article describing a series of 5 cases of adenomyosis provides an opportunity for conducting
a prospective study on the effectiveness of symptomatic treatment of adenomyosis.
Below are the comments that should be addressed.
- Adenomyosis treatment is not performed to save lives, but to relieve symptoms, and monitoring
the effectiveness of treatment is performed by observing the severity of symptoms. It should
be written what the Ca-125 monitoring contributes to the management of this disease; whether
the increase in concentration correlates in any way/precedes the appearance of symptoms (if so,
which ones). It should be written why adenomyosis biomarker should be sought.
- Adenomyosis can generally be confirmed in a histopathological examination. It should be
written on the basis of which features in imaging studies (and which ones) this entity was
diagnosed.
- The repeated sentence in lines 78-81 should be deleted.
- The sentence in line 219 requires improvement of meaning: "However, considering the broader
context of the serum CA125 level is essential, including its association with ovarian cancer and
implications for treatment efficacy. "
-The role of Ca-125 in diagnostics and treatment monitoring should rather be discussed in the
Introduction, and in the Discussion the dynamics of changes in Ca-125 concentrations during
the treatment applied in the context of the literature on this topic should be discussed.
Title: Changes in Canadian Contraceptive Choices: Results of a National Survey on Hormonal
Contraceptive Use
Version: 2 Date: 25 Jun 2024
Reviewer's report:
Comments
1. This is a paper on an online survey to determine the prevalence rates of contraceptive use in
Canada, to compare with previous surveys, and to describe other reasons for intake of hormonal
contraceptives. Since Canada does not have a more regular survey like the demographic and
health surveys, it may conduct health surveys from time to time. The last such survey was in
2011.
2. What was interesting in this survey was the establishment of a clear population at risk of
pregnancy, meaning those women of reproductive age who are regularly having intercourse.
There was also an objective to look at the other contraceptive options women had in the interim
since the last survey, but not including non hormonal contraceptive use as the main focus of the
survey was on hormonal use. Since there are other contraceptives that are non hormonal, these
could have been included in the survey questions. There are specific reasons why persons would
prefer non hormonal contraceptives, and it would have been interesting to ask about these.
3. There was an attempt to describe ever use patterns and current use patterns.
4. The survey attempted to have a geographic representative sample but in the results, some areas
only had a few participants. This may be improved in future surveys to get a more representative
sample from each geographic area.
5. Many of the socio demographic factors did not affect the level of contraceptive use. This may
be an actual effect, but it may be also an effect of a relatively sample size.
6. The decrease in the rate of OCP from 88 to 57% may be due to the increase of options of
contraceptive or maybe also be a shift to longer acting methods. It is interesting that the IUD
use increased to 28%.
7. The statements relating contraceptive use to the health care coverage are very important as
these support the belief that there will be more users if contraceptive use I covered by insurance
or government support..
8. It would be interesting to have a recommendation to have a regular survey to monitor
contraceptive use, such as every five years to have better indication of the trends of use.
Summary of recommendations:
1. Give a description on how the sample size of the survey was estimated.
2. If a comparison with a previous survey is to be made the similarities of the methodology and
the differences should be made to check if the trends analyses would be valid.
Title: Changes in Canadian Contraceptive Choices: Results of a National Survey on Hormonal
Contraceptive Use
Version: 4 Date: 17 Oct 2024
Reviewer:  Niklas Envall
Reviewer's report:
Thank you for the opportunity to read and review your article. The paper is well written,  shows
interesting results, and the conclusion is sound and based on the findings. A major limitation is
that the survey  did not include questions on reasons for non-use or use of HC. This was also
raised by the previous reviewers. This is not explained by the authors, but  when reading the
full methodology presented in an already published paper, this paper seem to present secondary
analysis  from  a survey with a complete different aim, which need to be elaborated on in several
places of the current paper.  This is important for transparency,  and would explain som of the
methodological limitations.
Please find my comments in the enclosed word file. Good luck with your paper!
Title: Expression of inflammatory states in response to psychological distress in breast cancer
survivors and its relationship to subjective memory function complaints
Version: 4 Date: 13 Jan 2025
Reviewer's report:
In the revised version of the manuscript, the authors have addressed most of the major and minor
issues raised, improving both the use of language, the methodological quality of the study, and
the structure of the different sections. In addition, the authors carefully considered the study's
limitations in the revised manuscript and corrected writing errors as suggested. I have no further
comments to make.
Title: Expression of inflammatory states in response to psychological distress in breast cancer
survivors and its relationship to subjective memory function complaints
Version: 4 Date: 14 Jan 2025
Reviewer:  Yori Gidron
Reviewer's report:
This is a very important study and it addressed a scientifically and clinically significant issue -
whether distress of women with breast cancer (BC) is related to chemotherapy-related cognitive
impairment (CRCI) and if inflammation explains this link. I recommend some revisions prior
to acceptance of the manuscript, as following:
Introduction: is well written. It includes all relevant and important information.
Methods:
1.  I see problematic for generalizability and restricted range of CRCI the exclusion criterion of
KPS > 80. Please add this to the limitations in the Discussion.
2. Please detail more the memory test – is it a self-reported measure of memory, and was
it validates against real measures of memory? If self-report, this needs to be mentioned as a
limitation as well.
Results:
1. In section 3.4, towards the end, there is an incomplete sentence which begins with "Bootstrap...
effects of...".
2.  The title of Table 3 has an error: RM instead of AM!
3.  Importantly,  I suggest to replace the tables on mediation with figures on the mediating role
of inflammation between DT and CRCI, using paths with the mediation coefficients. This will
be statistically and visually more clear.
Discussion:
1. The discussion on distress, inflammation and impaired cognition is at a very high level.
However, the authors only imply involvement of the sympathetic-parasympathetic systems and
they should mention possibly the role of little vagal nerve activity. This could then result both
in insufficient inhibition of inflammation, distress and in cognitive impairment since vagal
hypoactivity is related to all three.
2. Please add that Psycho-physiological interventions could be used and include HRV-
biofeedback since it increases vagal activity, thus reducing inflammation and distress.
Title: Expression of inflammatory states in response to psychological distress in breast cancer
survivors and its relationship to subjective memory function complaints
Version: 5 Date: 04 Feb 2025
Reviewer's report:
My comments have largely been addressed. There are still a few passages where the
interpretation of results appears to be incorrect.
1. In the title, the term "memory functioning" is still somewhat misleading.
2. In first to sentences of the conclusions, the terms memory function and memory performance
are used. However, the sentence refers to subjective memory complaints and should be phrased
accordingly.
Please check the entire manuscript if the language used reflects a correct interpretation of the
results.