PONE-D-22-00022Assessment of quality of life in asthmatic children and adolescents: A Cross sectional study in West Bank, PalestinePLOS ONE

Dear Dr. Khdour,

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.

Please submit your revised manuscript by Jun 10 2022 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.

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Kind regards,

Tai-Heng Chen, M.D.

Academic Editor

PLOS ONE

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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 #2: Partly

Reviewer #3: Yes

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

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 #2: No

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 #2: No

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 #2: General comments

The authors conducted a cross-sectional study whose aim was to investigate the quality of life (QOL) of children and adolescents with asthma. One hundred and thirty-two (132) participants were evaluated with the validated asthma control test (ACT) questionnaire and the pediatric asthma quality of life (PAQOL) questionnaire. The major finding was the low QOL scores seen among children with uncontrolled asthma. Although an interesting study (given the novelty in the authors’ clime), the authors need to address and clarify some major and minor issues on the manuscript for its improvement. For instance, the authors should state clearly the research question. Did they investigate if asthma control and severity affect QOL in children and adolescents with asthma? Or if there is a difference in the QOL between children with controlled and uncontrolled asthma?

Specific comments

Major issues

1. Abstract: For a manuscript of this nature (in line with the journal’s guidelines), I thought it should have been a structured abstract rather than an unstructured abstract. In line with the former, a background or introduction to the study should have been the first subheading. Under this subheading, the authors should have stated the research problem or gap they sought to solve or fill. I find the conclusion of the study findings rather curious. The authors stated: ‘Palestinian asthmatics children have surprisingly low quality of life, especially children with uncontrolled asthma.’ Were the authors not expecting children with uncontrolled asthma not to have low QOL? They should recall that they mentioned in the results that factors that affected QOL included disease severity, uncontrolled asthma etc.

2. Introduction: The first sentence needs referencing. The third sentence suggests (rightly so) that children with uncontrolled asthma have low QOL scores. Thus, I suggest the authors should mention previous studies on the QOL of children with uncontrolled asthma, and the QOL instruments used, the flaws (if any) on their use, and the advantage of using their chosen QOL instrument. These facts should form part of the justification of their present study. I do not agree with the statement before the study objective which read: ‘Although the treatment objectives for asthma are relative clear, the relationship between the asthma and the QOL of children is still not well-understood topic’ Rather, it is well documented that children with asthma has reduced QOL like children with other non-communicable chronic diseases such as nephrotic syndrome, chronic kidney disease and epilepsy.

3. Methods: The authors stated that the study was ‘a cross-sectional, analytical clinical.’ They should clarify the phrase. I would prefer to call the study ‘a cross-sectional comparative study’. It appears the authors compared the QOL of children with controlled asthma with that of children with uncontrolled asthma. Although the authors stated the sample size calculation and the inclusion/exclusion criteria, they failed to indicate their sampling method. The third item in their exclusion criteria were children who had difficulty in understanding the questionnaire. Why should it be so when the ACT questionnaire was administered by parental proxy? On the other hand, the PAQOL questionnaire was directly administered (self-administered) to the patients who were aged 6-17 years. Were the younger age groups able to understand the questions related to all the domains? Wouldn’t interviewer-administration have been a better option? Why was a non-generic health-related QOL questionnaire like PedsQLTM 4.0 Generic Core Scale not used as part of the study instruments? Given that asthma causes psychosocial disorders in children, this tool would have properly evaluated the psychosocial domain of the patients, which PAQOL could not achieve.

4. Results: This section was not clearly defined in the manuscript. I guess it started with the subheading titled ‘Patient characteristics’. The first sentence under the subheading is vague- ‘Of the 188 patients approached for this study, a total of 132 agreed to take part (response rate 70.2%).’ Was informed consent applicable to all the patients (stated age range of the patients was 6-17 years? The sentence also exposed the absence or the lack of clarity in the employed sampling method? The stated mean age was 8.6 ± 3.0. Was it in years or months? Table 2 appears redundant. I think the prose suffices. The title of Figure 1 should be modified for clarity. The subheading titled ‘The association between PAQOL, hospital admission and school absenteeism’ should be replaced by the title of Table 4 which aptly captures the discussion better. In Table 5, what is the meaning of the abbreviation ‘B’ and ‘Sig.’ for the variables predicting lower PAQOL scores?

5. Discussion: This section appears poorly written. In order to provide a robust discussion, I advise the authors to re-write this section using the following suggestions: (1) paragraph one should comprise a summary of the major research gap or problem they are trying to fill or address and its importance (2) paragraph two should provide a critical analysis of the major findings of the study and how they compare with previously published studies (3) paragraph three should discuss additional findings and how they fit with existing literature (4) paragraph four should be on study limitations (5) paragraph five can focus on future research directions (6) the last paragraph should be the overall conclusion and the major impact of this study (how does your study address the research question or fill the research gap?).

Minor issues

1. Several syntax and grammar errors litter throughout the manuscript. Given that the authors may not be from native English-speaking environment, I advise an English-language editing of the manuscript to make it polished.

Reviewer #3: Thank you to give me the chance to review the research paper “Assessment of quality of life in asthmatic children and adolescents: A Cross sectional study in West Bank, Palestine. The study is well organized and written, however, I have some comments which I hope the authors would consider to improve the quality of the manuscript.

Abstract

- Please rephrase the objective to become clearer

- In the abstract section No need to mention Inc., Chicago, IL, USA [optional]

- As the beginning of the paragraph please rephrase “ This indicated a better symptoms

- Control”

Introduction

- Could you add a paragraph to show the level of asthma control among pediatric in Palestine?

- As the last paragraph in the introduction of your study , rephrase the sentence to be fit with the aims in your study in Palestine

Methods

- In the ACT test would you mention the original validity and reliability of the questionnaire and NOT only at your setting

- Same to Qol questionnaire the original validity by the publisher

- Elaborate more, what was the average interview time or how long it took to complete the survey

- Were the pilot findings included in the study analysis? Not clear

Results

- You mentioned Number / % in some points you mentioned only %. Please be consistent

- In the text mention exactly the P-Values as expressed in the Table 4

- Also explain the numbers between brackets are percentages or SD

-

Discussion

- Rephrase “ Another indicator of less well-controlled disease is school absenteeism, which is likewise”

- The abbreviation of PQOL and Qol. please modify the manuscript accordingly

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Reviewer #2: Yes: Samuel Uwaezuoke

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Reviewers comments for PLOS ONE (QOL scores for asthma).docx

PONE-D-22-00022R1Assessment of quality of life in asthmatic children and adolescents: A Cross sectional study in West Bank, PalestinePLOS ONE

Dear Dr. Khdour,

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.

Please submit your revised manuscript by Jul 14 2022 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tai-Heng Chen, M.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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: (No Response)

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

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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

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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: After reframing the abstract,objectives, results and the discussion the study provides a valid conclusion that may help in planning a compressive care program for pediatric asthmatic patients.

Reviewer #2: You have substantially addressed my concerns about your manuscript. However, painstakingly go through your abstract section again to ensure that the information there is clear and aligns with the body of your manuscript. For instance, the following statement lack clarity- 'The participants with controlled asthma significantly score higher in symptoms control (P= 0.002), activity (P=0.004), emotional state (P=0.002) and in all over PAQoL scores (P=0.002) among control group.' The control group mentioned here, I guess, refers to uncontrolled asthma group. The 'cross-sectional analytic' study under Methods should align with 'Cross-sectional comparative' study mentioned in the body of the manuscript

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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: Yes: Samuel N Uwaezuoke

[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.

Assessment of quality of life in asthmatic children and adolescents: A Cross sectional study in West Bank, Palestine

PONE-D-22-00022R2

Dear Dr. Khdour,

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,

Tai-Heng Chen, M.D.

Academic Editor

PLOS ONE

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 addressed all the concerns and have made relevant changes to the manuscript. These amendments have increased the clarity of the abstract.

Reviewer #2: (No Response)

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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: Yes: Samuel Uwaezuoke

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