PONE-D-19-23460

Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe

PLOS ONE

Dear Dr Falah-Hassani,

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Kind regards,

Antonio Simone Laganà, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments:

The reviewers have expressed positive comments regarding your article, raising only few concerns. Considering this point, I invite authors to perform the required minor revisions.

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.  If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible

3. Please state whether you validated the questionnaire prior to testing on study participants. Please provide details regarding the validation group within the methods section.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Falah-Hassani and colleagues report on the clinical knowledge of 382 physicians from Finland, Denmark, Norway,

Estonia, and Sweden or Iceland.

1) The investigators note that Finland, Denmark, Norway, Sweden and Iceland) and Estonia share similar health care systems (Holm et al. Health Care Anal 1999;7:321-30). Are there any other reasons to aggregate these countries?

2) Overall, 43% of respondents were from Finland, much higher than the rest of the countries. How did this bias the results?

3) 75% of respondents were obstetrician-gynecologists. What was the power to detect trends for reproductive endocrinologists (which the investigators mention in their discussion of limitations) medical endocrinologists? Pediatric endocrinologists? General practitioners?

4) The questionnaire was part of larger international study conducted to inform translation needs for the new international PCOS guidelines published in 2018 (Gibson-Helm et al. Semin Reprod Med 2018;36:19-27). How do these data differ from the aggregated original data?

Minor:

a) Please include the questionnaire used.

b) Fig. 1 is difficult to interpret readily. Suggest a graph with 4 separate bar graphs, or better stil 'Box and Whisker Plot'.

c) It is unclear whether the data of this study being made available?

Reviewer #2: I was pleased to revise the manuscript entitled “Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe” (Manuscript Number: PONE-D-19-23460).

The study was approved by the Institutional Animal Care and Use Committee from Ponce Health Sciences University protocol #202 and from the University of Texas at rio Grande Valley protocol #2016-004. In general, this manuscript was aimed to investigate the physician reported awareness, diagnosis and management of PCOS and to explore the differences between medical disciplines in the Nordic countries and Estonia. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Methodology is accurate and conclusions are supported by the data analysis. Nevertheless, authors should clarify some point and improve the discussion citing relevant and novel key articles about the topic.

In general, the Manuscript may benefit from several minor revisions, as suggested below:

1. Abstract. I would suggest improving description of study design, the use of a survey is missed.

2. Methods. I would suggest providing further information regarding the questionnaire development.

3. Methods. How the surgery results were evaluated and introduced in the analysis? In example how the knowledge of POCS comorbidities was evaluated?

4. Accumulating evidence suggests that one of the most important mechanisms of PCOS pathogenesis is the insulin-resistance. For this reason, the use of insulin-sensitizers, such an inositol isoform, gained increasing attention due to their safety profile and effectiveness. Authors may better discuss this point, taking to account these recent articles: PMID: 30270194; PMID: 28835764; PMID: 30538744; PMID: 27737594.

Reviewer #3: The authors investigated in the present manuscript the "Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe". The topic is of scientific importance and deserves publication in your journal. It is generally well written with clear methodology and transparent results. The discussion is appropriately written and the limitations of the study are accurately presented. I believe that the manuscript would only benefit from a supplemental file (or a link) that would provide the actual questionnaire which could be used by future studies in this field.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe

PONE-D-19-23460R1

Dear Dr. Piltonen,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Antonio Simone Laganà, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Authors performed the required corrections, which were positively evaluated by the reviewers. I am pleased to accept this paper for publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have responded to the extent possible to all prior queries. How to obtain the data should be made more clearly.

Reviewer #2: I was pleased to revise the manuscript entitled “Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe” (Manuscript Number: PONE-D-19-23460).

This manuscript was aimed to investigate the physician reported awareness, diagnosis and management of PCOS and to explore the differences between medical disciplines in the Nordic countries and Estonia. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Methodology is accurate and conclusions are supported by the data analysis. Moreover, the authors performed all the suggested revisions and I appreciated the manuscript improvement.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No