Factors affecting anxiety among administrative officers working within the urgent protective action planning zone of a nuclear power station

Hiroko Hori; Makiko Orita; Yasuyuki Taira; Hitomi Matsunaga; Takashi Kudo; Noboru Takamura

doi:10.1371/journal.pone.0236997

Peer Review History

Original SubmissionJanuary 16, 2020
15 Jun 2020 Decision Letter - Haikel A. Lim, Editor PONE-D-20-01520 Factors affecting anxiety among administrative officers working within the urgent protective action planning zone of a nuclear power station PLOS ONE Dear Dr. Orita, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. I appreciate the amount of work the authors have put into this study, which is an important one given the lacunae in this area. There are a few minor issues to be addressed in this manuscript moving forward: in particular I hope the authors put extra focus on responding to Reviewer 1's comments on the somewhat problematic usage of "maternal characteristics of women" that appears throughout the manuscript. While I think many individuals may appreciate the innocuous sentiment behind the statement, the authors need to rephrase this or qualify the statement: are they referring to the societal duties imposed upon women, etc.? Please submit your revised manuscript by Jul 30 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Haikel A. Lim, MD, MSc Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 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. In addition, please provide any details of the pre-testing of this questionnaire that took place. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments (if provided): I appreciate the amount of work the authors have put into this study, which is an important one given the lacunae in this area. There are a few minor issues to be addressed in this manuscript moving forward: in particular I hope the authors put extra focus on responding to Reviewer 1's comments on the somewhat problematic usage of "maternal characteristics of women" that appears throughout the manuscript. While I think many individuals may appreciate the innocuous sentiment behind the statement, the authors need to rephrase this or qualify the statement: are they referring to the societal duties imposed upon women, etc.? [Note: HTML markup is below. Please do not edit.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: Yes ****** 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: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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 ****** 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: The article is an important contribution to the field. A few suggested edits are below: - The background primarily focuses on radiation exposure, but the article is focused on risk perception. Revising this section to highlight some data on risk perception would be more congruent with the paper. - The authors speculation on causes of significant findings requires more information. Particularly line 164 discussing the potential causal factor being "the maternal characteristics of women". This needs more explanation. The citations are also focused on burnout of nurses in the context of occupational stress and burnout. - The conclusions to build a comprehensive education program should take into account the degradation in trust in government authorities after the 3/11 disasters. Some acknowledgement of the research in this regard could also be cited in the conclusions and/or in the study limitations. Reviewer #2: The paper had been able to comply with the standards of the Journal. However, some few points needs to be define further. 1. How did they validate the questionnaires used in this study? 2. For the population sampling, how did you choose your study subjects? 3. Some few grammatical errors had been observed. Reviewer #3: There are not many studies on radiation anxiety related with nuclear plant disaster in Fukushima. This is a good research with technical soundness, appropriate statistical analysis, sharing of relevant data in the paper and written in standard English. ****** 6. 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 Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0236997.r001
Revision 1
26 Jun 2020 Author Response Dear Editor: We greatly appreciate your comments on our manuscript and provide point-by-point responses to the issues raised by the reviewers below. We have revised some sections of the text and added more information. In particular, according to your suggestion, we revised the text that reviewer 1 commented on as follows: “We indicated that females expressed greater concern about the health effects of radiation exposure than males, which is consistent with previous studies [7, 8]. This might be due to women’s motherly instincts, such as feeling anxiety about childbearing and raising children [7, 8, 13, 14]” (Page 14, Lines 175 – 178). Response to Journal Requirements: We greatly appreciate your comments on our manuscript. We have revised the manuscript according to your suggestions. We adjusted our formatting to ensure that our manuscript meets PLOS ONE’s style requirements including adding the captions for the Supporting information files at the end of the manuscript (Title page, Reference and Page 19, Lines 314 – 320). We added a copy of the questionnaire used in this study, in both the original language (Japanese) and English, as Supporting information Files S1 and S2. We added the following text in the Materials and methods section: “The questionnaire used in this study was developed based on questionnaires used in previous studies conducted in Fukushima Prefecture on intention to leave work [7, 8] and on the mental health and risk perception survey within the framework of the Fukushima Health Management Survey, which was organized by Fukushima Prefecture [4]. The questionnaire was verified with the confirmation of the local government office and Kagoshima University Graduate School of Health Sciences (No. 324). The original questionnaire form is provided in Supporting information File S1 and File S2.” (Page 5, Lines 98 – 104.) We added the captions for the Supporting information files at the end of the manuscript and updated references to these files in the text accordingly. (Page 5, Lines 103 – 104; Page 6, Lines 122 – 123; Page 19, Lines 314 – 320.) Response to Reviewer. Reviewer #1: We greatly appreciate your comments on our manuscript. We have revised the manuscript according to your suggestions. - The background primarily focuses on radiation exposure, but the article is focused on risk perception. Revising this section to highlight some data on risk perception would be more congruent with the paper. According to your suggestions, we revised the Introduction section. The description of radiation exposure is summarized as follows: “These measurements of external and internal radiation exposure of residents surrounding the FDNPS have been reported by several research institutions; they all suggest that external and internal radiation doses caused by the accident were relatively low and far from any direct health consequences in the general population [3].” (Page 3, Lines 38 – 41.) Text describing individual risk perception after the Fukushima accident and the relevant citations were added as follows: “Various information was transmitted to the public regarding the radiation-related health risk following the accident and many people in Fukushima felt anxiety about the health effects of radiation exposure, which resulted in social panic. The Fukushima Health Management Survey revealed that among evacuees of the Fukushima disaster, psychological distress was more frequent among people who perceived health effects of radiation exposure to be very likely, it appears that psychological status was related to the perception of radiation risks [4]. This result suggests that incorrect understanding of health effects of radiation may be related to psychological distress [5]. Furthermore, this anxiety was felt even in communities well outside of Fukushima [6].” (Page 3, Lines 42 – 50.) - The authors speculation on causes of significant findings requires more information. Particularly line 164 discussing the potential causal factor being "the maternal characteristics of women". This needs more explanation. The citations are also focused on burnout of nurses in the context of occupational stress and burnout. According to your suggestion, we revised the text as follows: “We indicated that females expressed greater concern about the health effects of radiation exposure than males, which is consistent with previous studies [7, 8]. This might be due to women’s motherly instincts, such as anxiety about childbearing and raising children [7, 8, 13, 14].” (Page 14, Lines 175 – 178). - The conclusions to build a comprehensive education program should take into account the degradation in trust in government authorities after the 3/11 disasters. Some acknowledgement of the research in this regard could also be cited in the conclusions and/or in the study limitations. According to your suggestion, we added the following to the conclusion section: “Also, it is necessary for administrative officers to build their credibility with the public through daily communication, and to disseminate accurate information about radiation [21]. From this point of view, it is important for administrative officers to develop a comprehensive educational program to build trust with the public and reduce public concerns about radiation exposure and its health effects with the cooperation of radiation medical science experts.” (Page 15, Lines 201 – 207). In addition, we have also added the following sentence as a study limitation: “…we could not obtain sufficient information on potential confounding factors, such as detailed lifestyle habits, educational environment, the degradation in trust in the central government after the Fukushima disasters and the responsibilities of study participants related to nuclear disasters.” (Page 15, Lines 212 – 216). Reviewer #2: We greatly appreciate your comments on our manuscript. We have revised the manuscript according to your suggestions. 1. How did they validate the questionnaires used in this study? According to your suggestion, we revised the Materials and Methods section as follows: “The questionnaire used in this study was developed based on questionnaires used in previous studies conducted in Fukushima Prefecture on intention to leave work [7, 8] and on the mental health and risk perception survey within the framework of the Fukushima Health Management Survey, which was organized by Fukushima Prefecture [4]. The questionnaire was verified with the confirmation of the local government office and Kagoshima University Graduate School of Health Sciences (No. 324). The original questionnaire form is provided in Supporting information File S1 and File S2.” (Page 5, Lines 98 – 104.) 2. For the population sampling, how did you choose your study subjects? According to your suggestion, we revised the Materials and Methods section as follows: “We distributed questionnaires to all 1,558 general administrative officers who worked at local public offices within the UPZ of Sendai Nuclear Power Station (SNPS) in Kagoshima Prefecture (Fig 1), which was the first nuclear power station restarted after the FDNPS accident in Japan. The 1,181 (75.8%) officers who provided complete responses to the questionnaires were included in the analysis.” (Page 4 and 5, Lines 84 – 89.) 3. Some few grammatical errors had been observed. According to your suggestion, a native English speaker checked the grammar in the revised manuscript. Reviewer #3: We greatly appreciate your comments on our manuscript. Attachments Attachment Submitted filename: 200626ResponseToReviewers.docx https://doi.org/10.1371/journal.pone.0236997.r002
29 Jun 2020 Decision Letter - Haikel A. Lim, Editor PONE-D-20-01520R1 Factors affecting anxiety among administrative officers working within the urgent protective action planning zone of a nuclear power station PLOS ONE Dear Dr. Orita, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== I thank the authors for their revised submission, which, based on my review, has adequately addressed the reviewers concern bar one. The sentence "This might be due to women’s motherly instincts, such as anxiety about childbearing and raising children [7, 8, 13, 14]" (lines 182-184) is problematic, primarily because of the use of "motherly instincts". I think the authors are trying to suggest that the concerns women might have are not a result of motherly or maternal instincts, but more on their future ability to bear healthy children. As such, the sentence may be better explained with something along the lines of: "While no qualitative exploration was done in this particular instance, it may be surmised that women, especially those of childbearing age, may be particularly concerned about the possible effects of radiation on fertility and progeny [7, 8, 13, 14]". If the authors are insistent on the use of "motherly instincts", then this discussion section will have to be expanded in order for the authors to adequately support their claim (through quantitative or qualitative studies) that health concerns are a result of female sex. ============================== Please submit your revised manuscript by Aug 13 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Haikel A. Lim, MD, MSc Academic Editor PLOS ONE Additional Editor Comments (if provided): I thank the authors for their revised submission, which, based on my review, has adequately addressed the reviewers concern bar one. The sentence "This might be due to women’s motherly instincts, such as anxiety about childbearing and raising children [7, 8, 13, 14]" (lines 182-184) is problematic, primarily because of the use of "motherly instincts". I think the authors are trying to suggest that the concerns women might have are not a result of motherly or maternal instincts, but more on their future ability to bear healthy children. As such, the sentence may be better explained with something along the lines of: "While no qualitative exploration was done in this particular instance, it may be surmised that women, especially those of childbearing age, may be particularly concerned about the possible effects of radiation on fertility and progeny [7, 8, 13, 14]". If the authors are insistent on the use of "motherly instincts", then this discussion section will have to be expanded in order for the authors to adequately support their claim (through quantitative or qualitative studies) that health concerns are a result of female sex. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0236997.r003
Revision 2
30 Jun 2020 Author Response Dear Academic Editor, We greatly appreciate your comments on our manuscript. According to your suggestion, we changed the applicable part as follows: from “This might be due to women’s motherly instincts, such as anxiety about childbearing and raising children” to “While no qualitative exploration was done in this particular instance, it may be surmised that women, especially those of childbearing age, may be particularly concerned about the possible effects of radiation on fertility and progeny”. (Page 14, Lines 176 – 179). Your kind support would be most appreciated. Attachments Attachment Submitted filename: 200630ResponseToAcademicEditor.docx https://doi.org/10.1371/journal.pone.0236997.r004
20 Jul 2020 Decision Letter - Haikel A. Lim, Editor Factors affecting anxiety among administrative officers working within the urgent protective action planning zone of a nuclear power station PONE-D-20-01520R2 Dear Dr. Orita, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Haikel A. Lim, MD, MSc Guest Editor PLOS ONE Additional Editor Comments (optional): Thank you for your revised manuscript. I am pleased to convey that this manuscript is ready for publication in PLOS ONE. Thank you once again for your submission and professionalism throughout the review process. I wish you the best of luck in your future research endeavours. Reviewers' comments: https://doi.org/10.1371/journal.pone.0236997.r005
Formally Accepted
23 Jul 2020 Acceptance Letter - Haikel A. Lim, Editor PONE-D-20-01520R2 Factors affecting anxiety among administrative officers working within the urgent protective action planning zone of a nuclear power station Dear Dr. Orita: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Haikel A. Lim Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0236997.r006

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