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Clinical gynaecological perspectives to improve validity in clinical research: comment on the article by Chiuve et al
  1. Shiho Oide1,
  2. Ryo Okubo2,
  3. Toshiharu Mitsuhashi3,
  4. Kota Fukai4,
  5. Hiroki Masuda5,
  6. Yoshie Yamada6,
  7. Takashi Yoshioka7
  1. 1 Department of Obstetrics and Gynecology, Kitasato University Medical Center, Kitamoto, Japan
  2. 2 Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Japan
  3. 3 Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
  4. 4 Department of Preventive Medicine, Tokai University School of Medicine Graduate School of Medicine, Isehara, Kanagawa, Japan
  5. 5 Department of Neurology, Chiba University, Chiba, Japan
  6. 6 Department of Healthcare Epidemiology, Kyoto University, Kyoto, Japan
  7. 7 Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
  1. Correspondence to Dr Yoshie Yamada, Department of Healthcare Epidemiology, Kyoto University, Kyoto, Japan; yamayosi89{at}

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We read the article by Chiuve et al with great interest. We appreciate the authors’ novel and interesting study using large US nationwide healthcare insurance data to determine the rate of mental health diagnosis in women with uterine fibroids (UF), a topic that has never been studied.1 However, for future clinical research, we have two suggestions regarding its external validity and internal validity from clinical gynaecological perspectives.

Our first concern is regarding its external validity. What clinical settings should gynaecologists extrapolate the results of this study to, for patients diagnosed with UF? …

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  • SO, RO and TM contributed equally.

  • Contributors SO, RO and TM wrote the manuscript with support from KF and HM. YY contributed to the final version of the manuscript. TY and YY supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.