JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: “It was my own decision”: The transformational shift that influences a woman's decision
to use contraceptives covertly
Version: 2 Date: 18 Mar 2022
Reviewer's report:
Brief summary
In general you aimed to explore the decision-making process through which women choose to
use contraceptives covertly.
Using the method of qualitative synthesis of empirical data acquired as part of a multi-
country evaluation of the delivery of integrated FP and childhood vaccination services through
semi-structured interviews, in-depth interviews, and focus group discussions. At two separate
moments in time, qualitative data was collected.
Women realized that, while they endured the negative repercussions of several pregnancies
and raising large families, they had little control over their fertility. Women felt comfortable
participating in CCU because they believed their husbands didn't even understand the
consequences or recognize their suffering, which justified not notifying them. CCU was a
challenging decision, but in environments where health providers were supportive, women felt
at ease to express their reproductive desires.
Title:
Why you prefer to do qualitative method? Do you think that your research question not answered
by quantitative methods
By default qualitative method of study is subjective result, how you avoid bias and how to
produce explicability?
Why not try to use the quantitative and qualitative methods, to minimize bias and to strengthen
your result?
The phrase in the quotation mark, if part of the title, it may not be simple for the readers
Abstract:
- Grammar correction
- Keywords should be next to abstract
Conclusion
- Line 76, why you wrote “who” in italics?
Background:
In general the introduction part is well written but lacks some information while stating the
problem that is, the impact of research gap.
Methods
This study is multi-nation study, do you think that, sociocultural characteristics of the population
in nations are similar? And can be generalizable? Rather, if country based data were available
why not review meta-analysis in the mentioned nations?
What was your methods for focus group selection for focus group discussion?
Discussion
Lines 527, 528, “This is the first time a SRH empowerment framework has been used to examine
the process through which women make the decision to engage in CCU” this sentence true as
the level of your understanding because you might not addressed all the journal using technical
search engines.
The discussion well written but it lacks the comparisons to other studies, and reason of difference
if there is a variation.
Title: “It was my own decision”: The transformational shift that influences a woman's decision
to use contraceptives covertly
Version: 3 Date: 10 Apr 2022
Reviewer's report:
Revised comment for authors
Your point-by-point response to the comments was satisfactory. Here is a minor grammar
correction in the abstract section:
Grammar correction in abstract
Minor corrections like two times for me better if two-times, “however women felt….,” use a
comma after however,” comfortable to voice…” better if comfortable voicing their…
Title: The relationship among psychosocial adaptation, medication adherence and quality of life
in breast cancer women with adjuvant endocrine therapy
Version: 1 Date: 28 Feb 2022
Reviewer's report:
Based on the abstract alone, I would not accept this manuscript for publication. The abstract
is very poorly written, and the research question's causal assumptions are not valid in this
reviewer's eyes. The Methods and Results sound very much like a fishing expedition for p-
values <0.005. The conclusion that "The QOL of breast cancer women with AET will be directly
affected by PSA" is not supported by the study, because it is based on cross-sectionally collected
data on two variables for which the association is likely bidirectional. The authors conclude that
we need to "improve the compliance of patients with medication, to better improve the QOL
"when the causal relation is very likely the opposite.
Title: The association between reproductive history and menopausal symptoms: an evidence
from the cross-sectional survey
Version: 1 Date: 01 Dec 2021
Reviewer's report:
Comments:
1. Define the aim of the study  in the end of introduction properly. Do mention the hypothesis
also.
2. The main outcome variable is confusing do represent it in a more comprehensive manner.
3. Why Kruskal-wallis and Mann-whitney  was done?  What do you mena by Multiple linear
regression analysis? Kindly define it Multiple linear regression analysis .
4. Were pre regression analysis done?
5. Please elaborate the limitation section.
6. Was table-3 adjusted for all other confounding variables? if yes do mention it.
7. Do provide proper footnotes in each table for short forms and symbols.
8. Do provide a supplementary file for pre regression analysis.
9.Please edit table-1 and 2. It is looking very clumsy.
Title: The association between reproductive history and menopausal symptoms: an evidence
from the cross-sectional survey
Version: 1 Date: 09 Dec 2021
Reviewer's report:
Authors  have made a splendid effort in shaping the manuscript. However, followings are the
observation:
1. Please describe the sampling method that you have adopted.
2. Comorbid condition  relating to respondents has not been described as that might be a
prognosis of menopausal symptoms & if comorbid condition is not a prognosis then please
mention that in your manuscript. The reason being data have been collected from patients who
have attended gynaecology clinic.
Thanks very much.
Title: The association between reproductive history and menopausal symptoms: an evidence
from the cross-sectional survey
Version: 2 Date: 01 Jan 2022
Reviewer's report:
Dear authors,
Thank you for incorporating the comments. I request that in the response file not only responses
but the comments given by the reviewers should also be mentioned. I request the same in the
subsequent revision. Please do this for 1st and 2nd revisions. I have a few more observations
in the revised version.
1.  In line 107; 92.88% of ... the sentence should not be started with the number.
2. In line 165; P=001.....This should be p<0.001. Wherever its P=0.001, do it p<0.001.
3. The title of the table-1 should be frequency and percentage.
4. The pre-regression analysis includes multicollinearity analysis, outlier analysis etc. Please do
that and give the analysis in the supplementary tables.
5. In Table-2 what is "Nolypar".
6.  The title "The association between reproductive history and menopausal symptoms: a cross-
sectional study" should be "The association between reproductive history and menopausal
symptoms: an evidence from the cross-sectional survey".
Title: The association between reproductive history and menopausal symptoms: an evidence
from the cross-sectional survey
Version: 3 Date: 26 Jan 2022
Reviewer's report:
BACKGROUND
WHO definitions of the stages of menopause (first paragraph) is not needed here as they are
provided in the methods section.
Sentence "The menopause transition is along with aging, and there is a significant overlap
between symptoms occurring with aging and menopause." It is unclear what is meant by "the
menopause transition is along with aging".
METHODS
In your response to reviewers you stated:
"Comment: As the study took place over an 11-month period, it seems many women were not
likely approached. Response: From 3801 women aged 35-65 who attended the gynecology clinic
during the study period, 294 women were approached, because sampling was done on some
days of the week."
However it remains unclear in the text why only 294 of 3801 were approached.  Please provide
information on the numbers of days per week or per month the interviewer attended the
gynecology clinic. Is 3801 the number of women who attended during the 11-month period in
total or is it the number who attended on the days the interviewer was present in the clinic? If
the latter, perhaps the better number to provide is the  number who attended on the days the
woman was present.
RESULTS
Number of Children,  and Number of Alive Children are included in the same regression model
y. Although they are each associated with the symptoms in the bivariate analysis, they are
undoubtedly co-linear (i.e. very highly if not completely correlated) and thus cannot both be in
the same regression model.  This prior comment has not been addressed.
It remains unclear how your models were built. You state in methods "Variables that were
significantly associated with the severity of menopausal symptoms (Table 2) were included in
the regression model."  However in Table 3 only  1 to 3 variables are presented in the table for
each model.   Did the regressions  in fact  include all significant variables from Model 2,  or
did you remove non-significant variables in the multiple regression step? If so by what process,
forward-selection? Backward selection? Or some other process?..
DISCUSSION
The discussion continues to present bivariate (unadjusted) results as  findings.  The discussion
should only present findings of the multiple regression (adjusted) analyses.
Number of children is in the final model, thus discussion should focus on the number of children
not on parity.
Title: The association between reproductive history and menopausal symptoms: an evidence
from the cross-sectional survey
Version: 4 Date: 11 Mar 2022
Reviewer:  Imke Janssen
Reviewer's report:
The authors have improved their manuscript, but there are remaining issues.
Given that only a small percentage (<10%) of women who visited the clinic were included in
the analysis, how do they compare with the rest? Older, poorer, fewer children, less likely to be
married? There must be at least some demographic information on all.
In the statistical methods section, it is stated that p<0.05 was considered statistically significant.
However, in the abstract as well as throughout the text, there are many instances where results are
highlighted as significant with p-value between 0.05 and 0.10 (i.e. only borderline significant).
The level 0.05 is somewhat arbitrary, but it is a well-accepted cut-point. The discrepancy needs
to be resolved. I would suggest eliminating all those borderline significant results.
In the results section, it is stated that "Women who were included in the study were not using
hormones and were naturally postmenopausal. " Clearly pre-and perimenopausal  women were
included in the study, so this sentence has to use "or" instead of "and"..
Choice of variables in regression analyses: the method of stepwise backward elimination (as
well as forward selection) has been much discredited. Instead, expert opinion is much preferred
in the selection of variables. In particular, sometimes we have to adjust for characteristics that
are not necessarily significant.
The Tables 1 & 2 are still way too busy.  My previous comments about presenting variables in
categorical as well as continuous fashion were NOT addressed.
Tables need to be able to stand on their own. You have provided explanations in the response
to reviewers that was not added in footnotes.  And capitalize the "W" in Kruskal-Wallis and
Mann-Whitney (and add "-" where needed).
The new references were not included in the introduction, only in the discussion in contrast to
what the authors claim in the response to reviewers.   It will require a renumbering of references.
Title: Perceived determinants of physical activity among women with prior severe preeclampsia:
A qualitative assessment
Version: 2 Date: 28 Feb 2022
Reviewer's report:
This research is good and practical.
I did not understand what the questions were in Surrey and how the women answered these
questions.
It is necessary to explain in detail about data collection tools.
It seems to be using one of the health models that I did not notice.
The article is too long.
Title: Perceived determinants of physical activity among women with prior severe preeclampsia:
A qualitative assessment
Version: 2 Date: 07 Mar 2022
Reviewer's report:
This qualitative study explored the perceived determinants of physical activity among women
with prior severe preeclampsia, which is an interesting topic. However, some major and minor
comments are as follows:
1. In the Introduction section, the authors described a novel theory IBC model. It would be
better if the authors could add more information about the model here, such as the motivational,
volitional, and automatic processes of the model in this section to make it more understandable.
2. How the anonymous online survey was administered in the study? It was done by written
questions or conversations? Please clarify the details of the online survey in the Method section.
3. The IBC model mainly summarizes the psychological factors and processes that affect the
behavior. Whether it is proper to include environmental factors in this model?
4. The Ref. 19 and 20 are the same. Please clarify this.
5. The English language should be improved throughout the manuscript.
Title: ONLINE INFORMATION ABOUT MAMMOGRAPHY SCREENING IN ITALY
FROM 2014 TO 2021
Version: 2 Date: 24 Nov 2021
Reviewer:  Per-henrik Zahl
Reviewer's report:
My two main objections are
1. The paper should report the proportions of web pages giving information about reductions in
breast cancer mortality as well as in reductions in total mortality.  The latter is zero, I suppose. If
you tell women there is no scientific evidence that there is a reduction in total mortality, women
would not attend screening.
2. The paper should also present quantitative data on harms and benefits. Not only the proportion
reporting each issue (Table 2). For example, how many get false positive mammograms and
what is the level of overdiagnosis. Even these data are rarely reported, the portions of studies
not reporting these data should be presented in Table 2. At bottom of Table 2 the authors report
how many give quantitative data on reduced mortality risk. This could have been presented as
mean reduction or the range of reductions. Quantitative data give information about the validity/
truth in the information.
Some minor comments.
There are too many irrelevant references. Start with deleting reference 2.
I prefer to use the term “benefint-harm” instead of “risk-harm”.
Why do you include information about radiation exposure as harms? This is not harmful at all.
What is a biopsy-proven false positive result?
Information about lead time bias is not relevant here, I think. Lead time bias is difficult to explain
even to scientists because, most overdiagnosed tumors do not have lead-time. Then lead-time
bias becomes an abstract and difficult thing to explain.
Title: ONLINE INFORMATION ABOUT MAMMOGRAPHY SCREENING IN ITALY
FROM 2014 TO 2021
Version: 2 Date: 02 Feb 2022
Reviewer's report:
The manuscript reports risk/benefit/harm information of breast cancer screening posted on
public health Italian services websites. It also compares results with the previous study
conducted in 2014 with the same methodology: two medical researchers independently analyzed
documents addressed to women in the websites.
The strength of the work is that it points out an existing lack of information about a delicate
issue and it can measure improvements in seven years.
The weakness is a prejudice in the discussion and in some results reported by the authors, that,
in my opinion, cannot be claimed from data collected.
Title: ONLINE INFORMATION ABOUT MAMMOGRAPHY SCREENING IN ITALY
FROM 2014 TO 2021
Version: 4 Date: 28 Mar 2022
Reviewer:  Per-henrik Zahl
Reviewer's report:
I only have some small editorial comments:
1. Abstract, Results, first line: Write “reduction in breast cancer mortality (58.2%)” Also do it
in the fifth sentence.
2. Abstract, Results: Write “false positive mammogram” and not “false positive result”
3. Introduction: Forth line: …reducing breast cancer mortality….
4. First line page 4: write “….the reduction in the breast cancer mortality (58.2&, Table 2)….
You do not have to specify breast cancer mortality all over in the manuscripts, but some places
you must mention that you study breast cancer mortality and not total mortality.
5. Discussion, second paragraph: ….. reported risk factor of breast cancer screening….
Title: The Value of p16 INK4a Immunostaining for High-grade Squamous Intraepithelial
Lesions in Human Papillomavirus–negative Patients
Version: 0 Date: 02 Dec 2021
Reviewer's report:
The paper provides additional strong support for  the value of p16 staining for predicting HSIL
or worse, in particular among HPV negative patients who underwent colposcopy. The paper is
generally well written and clear. In order to generalize these results to other populations, there
are several areas that need further clarification;
1. The study population needs to be better described. Who is seen in this clinic? Does this include
people with prior HSIL or HPV?
2. What do you mean by severe clinical symptoms (p.5) How many patients had neg
cytology,neg HPV and “severe symptoms” had HSIL+?
3. What cervical cancer screening guidelines are you referring to-please add reference or explain.
(p.5)
4. Hybrimax HPV blot test was used for the majority of the patients and I am not sure how to
interpret a “negative” test.  What is the sensitivity/specificity of this test compared to validated
standards? I was able to find one article comparing the results to Hybrid Capture 2, but I would
be interested in knowing how it compares to other tests more commonly in the US. In particular
what is the negative predictive value of this test if so many of the patients who tested negative
actually had an HSIL finding?
5. Did all patients who underwent a colposcopy have at least one biopsy (p. 7).  Of the 62/122
HRHPV negative patients who were reported as WNL, was that by visual colposcopy or was
that confirmed by biopsy (p.9)?
6. The limitations of the study section makes some good points but could benefit from some
editing of the English.
Title: The Value of p16 INK4a Immunostaining for High-grade Squamous Intraepithelial
Lesions in Human Papillomavirus–negative Patients
Version: 2 Date: 26 Feb 2022
Reviewer's report:
The authors have made all the changes suggested by the reviewers. This is an interesting study
that demonstrates that not all HSIL are HR HPV positive, and that p16 ICC is of added value
in the diagnosis of such lesions.
Title: The Value of p16 INK4a Immunostaining for High-grade Squamous Intraepithelial
Lesions in Human Papillomavirus–negative Patients
Version: 2 Date: 15 Mar 2022
Reviewer's report:
I do not understand why HPV negative women were subjected to cytology and colposcopy.
There is no clarity how high grade lesions were picked up at the start.
Title: The Value of p16 INK4a Immunostaining for High-grade Squamous Intraepithelial
Lesions in Human Papillomavirus–negative Patients
Version: 2 Date: 16 Mar 2022
Reviewer:  Cihan Kaya
Reviewer's report:
The paper is well written with a clear language
The authors have mentioned about the study limitations.
In introduction section please provide more details regarding the deficit of cytology by referring
the study DOI: 10.17772/gp/60980
Title: The Value of p16 INK4a Immunostaining for High-grade Squamous Intraepithelial
Lesions in Human Papillomavirus–negative Patients
Version: 3 Date: 02 Apr 2022
Reviewer:  Cihan Kaya
Reviewer's report:
The authors have made all the changes considering suggesteions. This is an interesting
study  with reliable outcomes .
Title: Relationship between bone mineral density and ovarian function and thyroid function in
perimenopausal women with endometriosis: A prospective study
Version: 1 Date: 09 Sep 2021
Reviewer's report:
1. The title of the manuscript is reductive. In fact, the paper shows a relationship between bone
mineral density and ovarian function, but it also considers the involvement of thyroid gland
hormones, whose leading role should be emphasized.
2. In the Introduction (page 4, lines 16-18), Authors state that there is a highlighted relationship
between endometriosis and thyroid autoimmunity. More recent evidence supporting these data
should be included.
3. It is well known that perimenopausal women with endometriosis require a careful
management (Alio L. et al, ‘Endometriosis: seeking optimal management in women approaching
menopause’. Climacteric. 2019 Aug;22(4):329-338) and that the long-term use of hormonal
treatments may influence both the ovarian reserve and the bone mineral density in these patients.
However, there is a relevant criticism in the present study: data were extracted only from women
with endometriosis. Nevertheless, to assess significant differences, a control group including
menopausal women with no history of endometriosis should be considered. Furthermore, the
type and duration of treatments in affected patients should be evaluated as a considerable bias.
4. The results are very interesting, but confusing. To improve the understanding, Authors should
divide the text into sub-paragraphs, each one regarding an individual topic.
5. Evidence show that the ovarian reserve is better expressed by the concurrent evaluation of
both anti-Mullerian hormone (AMH) and antral follicular count (AFC). In the present study,
Authors aim to evaluate the ovarian reserve through the only measurement of AMH levels,
with conventional, non-highly sensitive, tests. However, the AFC is essential and gives relevant
information regarding the ovarian function in perimenopausal women, especially in cases of
long-term medical treatment. Please evaluate this combined approach in future perspectives.
Therefore, despite the interesting and complex work, I feel that, at present, the paper does not
reach the standards for publication in BMC Women’s Health.
Title: Relationship between bone mineral density and ovarian function and thyroid function in
perimenopausal women with endometriosis: A prospective study
Version: 1 Date: 17 Jan 2022
Reviewer:  M Ikram Khatkhatay
Reviewer's report:
The authors investigated the relationship between BMD and ovarian function in perimenopausal
with endometriosis. The authors have adequately argued about the need to study the relationship
between endometriosis and BMD in perimenopausal women. Their study methodology was
nicely chalked out. Unfortunately, the differences between the first (1st BMD= 1.16±0.15;) and
second (BMD=1.15 ± 0.16) measurements BMD is negligible (0.02 ± 0.02). The authors should
first show that the difference between the 2 measurements is statistically significant.
Moreover, the correlation coefficient between BMD and other parameters, though significant,
is very low.
The authors have divided BMD values into tertiles (1st 1.11± 0.19; 2nd 1.17 ± 0.14; 3rd 1.15 ±
0.13), I am sure the 95th CI of these 3 groups must be overlapping. They should do ANOVA of
these groups (Table 5) and report P values of all along with their 95% CI.
They should present a table where values of 1st and 2nd measures are shown in adjacent columns.
They should define site BMD measurements (spine/femur/whole body?). They should also
report CV of BMD measurements on DEXA.
The BMD is not a sensitive marker to check bone loss over a period less than 1-2 years.
They should have included estimation of bone resorption markers (such CTX, DPD) which are
sensitive to understand bone resorption in less than 3 months.