JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Developing a Framework to Describe Stigma Related to Cervical Cancer and HPV in
Western Kenya
Version: 1 Date: 23 Nov 2021
Reviewer's report:
Overall: The authors have addressed a very important issue in increasing uptake of cervical
cancer screening in SSA. The choice of individuals to include in this study was generally
appropriate and the lack of individuals with a positive HPV+ screening test was appropriately
acknowledged as a limitation. In particular, it is excellent that the interviews included both
HIV positive and negative women in this study.  Previous work has identified different levels
of stigma between HIV pos and neg women. Additionally, the discussion about the potential
interaction between HIV and HPV stigma was presented well. I have minor comments to
consider in the revision of this manuscript as outlined below.
Minor comments:
Background section:
(1) WHO should be defined when first used
(2) Additional background about HPV screening as a method for cervical cancer / pre-cancer
screening as well as background on HPV vaccination would strengthen this section
Results:
(1) Is it standard practice to include the person’s identification number after the quote? I think just
indicating what category the person was in would be sufficient and less potentially identifying.
Discussion:
(1) I recommend acknowledging that there may be some bias in the women willing to participate
in this type of study; this population may actually represent women who are least affected by
stigma associated with cervical cancer and HPV – in other words, even in this study, stigma
may be underestimated.
(2) Similarly, I recommend acknowledging that, by the nature of qualitative studies, this
represents the opinions of a small number of individuals and may not be entirely representative
of the community at large. It seems as if similar themes were being mentioned by multiple
different individuals which helps assuage this concern, but that could also be clarified if it is
indeed the case. The inclusion of two different types of HCWs who have experience with many
patient may also help with this limitation.
(3) HPV screening, particularly self-screening is much less invasive than cervical cancer
screening with other techniques such as VIA/VILI or pap smears. The progress towards these
less invasive and less feared/stigmatized screening procedures is an important advancement in
improving uptake of screening. This is a huge win! However, if positive, women would still
need to undergo more invasive procedures for diagnosis and treatment of cervical cancer and
these procedures. Because this study seemed to focus on HPV screening, it may not have fully
characterized the stigma associated with downstream procedures (fear of the speculum exam  -
due to both pain and stigma - have been identified in other studies as barriers to cervical cancer
screening in East Africa). Touching on this issue would strengthen the discussion.
Title: Hyaluronic Acid Gel Application versus Ovarian Suspension for Prevention of Ovarian
Adhesions during Laparoscopic Surgery on Endometrioma: A Double-Blind Randomized
Clinical Trial
Version: 3 Date: 06 Jul 2021
Reviewer:  Giovanni Scambia
Reviewer's report:
The paper have to be revised from a native English. The figure 2 have to be send in a different
format because it is out of focus. In the methods you have to better describe the technique by
which the ultrasonographer evaluate the presence of adhesions
Title: Hyaluronic Acid Gel Application versus Ovarian Suspension for Prevention of Ovarian
Adhesions during Laparoscopic Surgery on Endometrioma: A Double-Blind Randomized
Clinical Trial
Version: 3 Date: 09 Jul 2021
Reviewer's report:
The research was well done with a very good idea. The greatest strength of the study is the
randomization of the participants' ovaries. The second advantage is that the adhesion was
evaluated non-invasively through ultrasound.
I have some comments.
1. The inclusion criteria and exclusion criteria should be described.
2.  Information on type of randomization, block size, allocation sequence, and allocation
concealment should be described.
3. The researchers performed external suspension of the ovary through the abdominal wall. Why
did the authors not consider internal susupension to be fixed in the abdominal cavity?
4. On the 3rd day of surgery, the suspended ovary was cut from the abdominal wall, and
discusison is needed to determine whether too early did not affect the results.
Title: Hyaluronic Acid Gel Application versus Ovarian Suspension for Prevention of Ovarian
Adhesions during Laparoscopic Surgery on Endometrioma: A Double-Blind Randomized
Clinical Trial
Version: 5 Date: 28 Oct 2021
Reviewer's report:
The authors appropriately revised the paper according to the reviewers' comments.
Considering the originality and academic value of the study, it is judged that this study is worthy
of publication.
Title: Hyaluronic Acid Gel Application versus Ovarian Suspension for Prevention of Ovarian
Adhesions during Laparoscopic Surgery on Endometrioma: A Double-Blind Randomized
Clinical Trial
Version: 5 Date: 31 Oct 2021
Reviewer:  Giovanni Scambia
Reviewer's report:
The study was well conducted and its strength is surely the randomization of the ovaries with
a double blind re-evaluation.
Some comments:
1) the paper have to be extensively revised by a native English
2) Figure 2 have to be sent in another format because it is totally out of focus
3) the inclusion and exclusion criteria have to be better described
4) authors have to describe in the method why the suspended ovary was released after 3 days
5) authors have to better describe the technique by which sonographer evaluate adhesions and
to better describe Operative Laparoscopy Study Group (OLSG) classification, revised ASRM
classification and ultrasonography soft markers
6) at the beginning of the discussion, author wrote "These results are in line with that of previous
studies, suggesting Endogel as an effective adhesion-preventing factor (11, 12, 15)": control
reference 15, because it refers to ovarian suspension and not to the use of hyaluronic acid gel.
Title: Hyaluronic Acid Gel Application versus Ovarian Suspension for Prevention of Ovarian
Adhesions during Laparoscopic Surgery on Endometrioma: A Double-Blind Randomized
Clinical Trial
Version: 7 Date: 22 Dec 2021
Reviewer:  Giovanni Scambia
Reviewer's report:
Dear Authors,
Thanks a lot for your answers to my comments. You did a great job!.
I will send you the manuscript back with very minor revisions highlighted in green.
Title: Reasons for low utilization of Intrauterine Device utilisation amongst short term
contraceptive users in Hossana Town, Southern Ethiopia: a qualitative study
Version: 1 Date: 22 Nov 2021
Reviewer:  Susan Walker
Reviewer's report:
It was a pleasure to read this well written paper reporting on an important topic.
I have a few suggestions that you may want to consider for revision of the paper.
p3. 1st paragraph of Introduction : Rather than "there has to be concerted efforts to increase the
utilisation of Intrauterine devices (IUDs)  " you might consider “highly effective, long-acting
methods like IUD”  instead of just "IUDs" in order  to preserve the notion of user choice.
2nd para. You need a reference for your data about unintended pregnancies in 2012 - placed at
the end of the sentence.
3rd para. A short description of IUD methods and their efficacy would be helpful. It is not
entirely clear if you refer to copper IUDs or IU contraception as a whole including IUS.
p5. Last sentence . Rather than "anonymous" it might be better to report that participants were
“anonymised” – given that their identity was known but hidden to the reader.
p.6 Results section . You might consider putting all of the demographic data into a single Table.
The Results section might be improved by providing a separate theme of ‘Myths and
misinformation’. It seems to be slightly different from ‘Inadequate counselling and poor
information from health care providers’
It would be very interesting to know if your two health care providers had an opinion on
inadequate counselling or the absence of trained personnel.
Discussion Section: p.11 In general you should place your findings in the context of previous
research in a more comprehensive way, especially research arising from low income settings.
For instance, there is much previous research detailing that women have misinformation about
IUDs. It would be good to refer to some here.
p.12 Do you have any thoughts on how better information on IUDs could be provided for your
population? Written leaflets? Meetings with speakers? Video or social media information?
Title: Reasons for low utilization of Intrauterine Device utilisation amongst short term
contraceptive users in Hossana Town, Southern Ethiopia: a qualitative study
Version: 1 Date: 04 Dec 2021
Reviewer's report:
Dear Authors,
The area of your study is an important issues in exploring reasons for the low utilization of
IUCD, which can contribute a lot in improving family planning services in Ethiopia and beyond.
But,  the methodology used did not answer the objectives set in your study. This is primarily
because of the selection of a qualitative study design which might have been a complementary
to a qualitative study covering a larger sample and users form both urban and rural areas.  For
someone looking at the title of your manuscript, one can expect a lot to see on the utilization
data and other factors associated with it, which is not reflected in the current manuscript. As
authors from a teaching institution, I still encourage you to do a larges sample study with the
inclusion of both quantitative and qualitative methods.
Title: miR-140-3p is a potential differential biomarker in benign phyllodes tumors and
fibroadenoma of the breast
Version: 1 Date: 27 Oct 2021
Reviewer's report:
The manuscript is well written and easy to understand.
The methods of the small RNA experiment should be elaborated. The referenced paper does not
provide sufficient information to understand the performed analysis. There are also descriptions
on isomiR countrification, which is not used in this paper?
The methods for differential expression analysis are important and should be described in detail.
The data should be publicly available eg. at GEO/SRA.
There seem to lack some detail on how the reverse transcription is performed. What is used for
the reverse transcription primer?
The authors mention gene chip data in the paper. This is most likely the miRNA-seq experiment?
The paper mentions expression as signal value. This term is unclear. Please change.
Figure 2C: mean center the values and maybe sort the values from lowest to highest expressed
and leave out the clustering of miRNAs.
Figure 3B, 3D, 3F show the same as 3A, 3C, 3E? then only use 3B, 3D, 3F and change 3I to
the same type of plot.
When the focus, in the end, is a singular microRNA I find it interesting to investigate the genomic
context of the microRNA. The MIR140 gene is located in WWP2 and is co-transcribed, I,
therefore, find it obvious to extend the analysis to include WWP2. This should include a qRT-
PCR test if the host gene is also differentially expressed between Benign phyllodes tumors and
fibroadenomas.
Title: Effect of theory-based education on promoting a healthy lifestyle in pre-diabetic
women:RCT
Version: 2 Date: 11 Aug 2021
Reviewer's report:
Needs an extensive language revision by professional language expert.
Introduction: Objectives are not clear. Need to explain why only women were included.
Abbreviations needed to be introduced / explained at the first time they appear in the manuscript.
Methods: The first sentence should be in the past tense.
Why only one reading of FBS was used to assess the glycemic control? I Suggest to discuss
why glycosylated hemoglobin not used.
Inclusion criteria : not "people" you included women 30-60 years.
Last sentence of methods is an objective. (Wrong place)
Measurements: Needs laboratory technical details about FBS measurement. What is the
instrument/ tool used to  assess the physical activity? Is it a validated tool?
Intervention:  Details of TBP should be mentioned. What type life style, diet, physical activities
modifications included ?
Results: Group comparison at baseline characteristics (descriptive stat) comorbidities  should
be given.
How do authors say two groups are identical? Need evidence by comparing characteristics such
as age, weight, height, BMI, level of education (socio economic status). Do not expect to be
identical. May be statistically not different. Control groups seems to be more hypertensive and
with more hyperlipidemia. (So they are different groups)
Second para: blood lipids and blood pressure are not diseases. Hyperlipidemia and hypertension
must be meant by authors.
Tables: 2 types of p values are there. Define them with stars* in the table legend.
Tables should be supported with text in the results section.
Discussion: Need to discuss possible explanations for some unexpected findings.
Limitations and strengths ?
Title: Effect of theory-based education on promoting a healthy lifestyle in pre-diabetic
women:RCT
Version: 2 Date: 13 Aug 2021
Reviewer's report:
Background
Would you please add a research hypothesis based on the TPB rationale?
Results
In this study, if the adjusted values were not reflected for the intervention group having a higher
diet-related attitude or behavior score than the control group in the baseline, please present the
results by adjusting the difference between the baseline.
Discussion
In this study, it seems difficult to explain the increased diet score of the intervention group
because all TPB variables did not significantly improve. Would you please explain in more
detail why diet and physical activity-related intention and behavior did not significantly improve
despite providing an intervention method as a TPB rationale?
Would you please describe the point in which the minimum number of samples could not be
maintained and methods to improve it in the limitation?
Title: Effect of theory-based education on promoting a healthy lifestyle in pre-diabetic
women:RCT
Version: 2 Date: 20 Aug 2021
Reviewer:  Azita Fathnezhad-kazemi
Reviewer's report:
# Abstract
Comment 1: in the abstract, what does it mean “randomized educational trial” is it a randomized
controlled trial.
Comment 2:  If you did not apply random allocation, the study type isn’t RCT because random
allocation is necessary.   In my opinion, your study type is “A cluster#randomized controlled
trial”
Comment3: in the method section it was mentioned the questioners were completed after training
for both groups. Did you conduct an intervention in both groups?
Comment4: in the result, please correct the fasting blood sugar’s report [(99.70 11 11.06)]
# method
How did you choose the health centers and participants? Please explain in detail. How did you
conduct randomization? Please explain about cluster?
Which variable has been used for calculating the sample size “the mean(SD) is related to which
variable?”
According to the study title, the primary outcome is “promoting a healthy lifestyle” but in
the method section you have mentioned “primary outcomes included changes in knowledge,
attitude, subjective norms, perceived behavioral control, behavioral intention, and secondary
outcome included promoting a healthy lifestyle in pre-diabetic women’s” also you have reported
fasting blood sugar. So what is this?
Please explain why were the participants dropped from each group
#Result
According to the CONSORT statement, table 1 should be reported baseline demographic and
clinical characteristics for each group.
Title: Effect of theory-based education on promoting a healthy lifestyle in pre-diabetic
women:RCT
Version: 4 Date: 12 Nov 2021
Reviewer's report:
In this study increased diet score of the intervention group because almost TPB construct
(attitude, perceived behavior control, intention and knowledge) increased after intervention.
(Discussion section, paragraph 2, line 1, page 10).
=> In this sentence, it is judged that it is difficult to lead the discussion to a simple comparison
that the TPB score related to the diet was higher after the intervention than before the
intervention. The control group, who took no action, also had improved post-test scores
compared to the pre-test.
Rather, diet-related intention scores were higher in the control group than in the intervention
group. Therefore, I think that the discussion should be appropriately described because there
was no statistically significant difference.
Title: Mothers with depressed mood: Help-seeking from husbands and child-rearing behaviors
Version: 2 Date: 12 Nov 2021
Reviewer's report:
I liked this paper. It was interesting and well written. It took me a little while to get used to the
language and the way it was written but as I read on and got used to it, it became clearer. i found
the quotes from the mothers really helpful in bringing it to life.
Title: Visual Appearance of the Uterine Cervix Differs on the Basis of HPV Type Status in
High- Grade Squamous Intraepithelial Lesion: The Results of a Reliable Method
Version: 2 Date: 02 Oct 2021
Reviewer's report:
This study represents a proof-of-concept of the feasibility of implementing “ImageJ software”, a
free image analysis software developed by the NIH to quantify colposcopic findings objectively.
Colposcopy has a key role in the management of cervical precancerous lesions; however its
inherent subjectivity is reflected in the poor correlation with the gold standard of histologic
assessment of cervical transformation zone in conization specimens. Several approaches and
algorithms have been proposed so far to enhance colposcopy performance. As the authors also
underscore, in the following years the anticipated reductions in HPV 16 prevalence following
successful vaccination schemes and the potential type replacement issues will ultimately make
pattern recognition during colposcopy more painstaking. Therefore the implementation of
computer-assisted diagnosis in colposcopy is paramount.
The Abstract and Introduction Sections are well developed. Two additional paragraphs might
be useful in the Introduction; the first being a brief review of computer aided diagnostics (CAD)
in colposcopy practice made so far. Noteworthy; the “DYSIS” software and related interface
is an established computer assisted diagnosis of colposcopic images approved by the British
National Institute for Clinical Excellence (NICE) that needs mentioning since it is additionally
CE marked and FDA-cleared. One additional paragraph should provide some insight on the
“ImageJ software”.
The Methods section is accurate and the sample size is adequate. The authors should reason
their choice to use these particular HPV subgroups classification (rows 113-118); was this done
arbitrarily, was it based on HPV phylogenetics or other criteria?
The Results section is detailed and accurate, Tables and Figures are seemingly well-prepared.
The finding that HPV-negative lesions are prone to be large might reflect that histologically they
essentially represent immature metaplasia.
The Discussion section can be revised to adopt a more clinician-oriented form. The findings in
paragraph in rows 311-324 corroborate well-established epidemiological patterns but fall outside
the scopes of the study. Instead the authors should focus on the clinical utility of CAD approaches
in colposcopy practice.
References are current.
Overall, a very interesting manuscript with adequate methodology and a potential for
contribution in the field.
Some minor language polishing might be required.
Title: Visual Appearance of the Uterine Cervix Differs on the Basis of HPV Type Status in
High- Grade Squamous Intraepithelial Lesion: The Results of a Reliable Method
Version: 2 Date: 15 Oct 2021
Reviewer's report:
A very interesting manuscript with an interesting topic. It is highly important for the future to
evaluate these HPV genotype specific differences as the HPV vaccinated women are coming to
cervical cancer screening programs. This will lead to the decrease of HPV16 and 18 lesions and
the knowledge on the other HPV types to the colposcopy evaluation is crucial.
One question:
In HPV grouping was in the hpv16 as hpv18 multiple type groups 16 excluded from 18 multiple
type and 18 excluded from 16 multitype group? Was there too little number to have these as
single infection only?
Title: Visual Appearance of the Uterine Cervix Differs on the Basis of HPV Type Status in
High- Grade Squamous Intraepithelial Lesion: The Results of a Reliable Method
Version: 4 Date: 07 Dec 2021
Reviewer's report:
In their revised manuscript, the authors have addressed several identified weaknesses of their
manuscript.
The Discussion section in particular, has been largely improved. The observation that “HPV-
negative HSIL patients showed typical grade 2 vascular patterns second only to HPV16-positive
women” (rows 341-2) could be attributed to the natural cycle of the HPV itself; when an
episomatic infection becomes integrated then this HPV genotype’s DNA is no longer expressed.
From that point on, mRNA HPV can be detected.
There is still some room for further language polishing.
Title: Female Genital Mutilation and Skilled birth attendance among women in sub-Saharan
Africa: evidence from demographic and health surveys
Version: 3 Date: 23 Sep 2021
Reviewer:  Ismael Jiménez-ruiz
Reviewer's report:
Due to its magnitude and the international character of the study the results are relevant to give
a concrete picture of the status of FGM and its relation to assisted childbirth. It is therefore of
interest for publication. Still it needs minor revision of some aspects which I detail.
Abstract:
Do not use abbreviations in the abstract.
In the methodology section indicate the source of the surveys and the 10 countries included.
Formal aspects.
Revise bibliographical references. Specifically reference 22. It would also be advisable, in some
cases, to carry out a new bibliographic review to update certain references that are more than
5 years old.
Background
When addressing the causes of female genital mutilation in the first paragraph of the
Background, it is necessary to stress the gender perspective and how the construction of gender
from a patriarchal point of view generates the inequalities that lead to this type of practice.
There is bibliography that supports this argument and it is fundamental if we are to make
recommendations to international organisations.
The Background would benefit from including the pre-existing relationship between qualified
care and non-FGM. This would facilitate the understanding of the relationships established in
the results.
The aim of the study should be phrased in the infinitive form.
Methods:
The study design should be included at the beginning of the section.
Regarding the sample, it is mentioned that the sample consisted of 57,994 women. Was there
any screening process to generate the sample or was the total number of respondents between
the stipulated years used?
More information on the methodology of the survey, who conducted it and how it was conducted
would need to be included. Also what was the recruitment process and access to the survey data.
Discussion:
If possible, it would be advisable to establish the literature review with more up-to-date literature.
Title: Female Genital Mutilation and Skilled birth attendance among women in sub-Saharan
Africa: evidence from demographic and health surveys
Version: 5 Date: 07 Nov 2021
Reviewer:  Ismael Jiménez-ruiz
Reviewer's report:
Regarding the inclusion of a more detailed reflection on the analysis of the causes of female
genital mutilation from a gender perspective. Although the gender perspective is mentioned, the
analysis is not deepened. My recommendation is that for a correct justification it should broaden
and deepen this issue.
The response to the other points of the review are adequate.