Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2

Laís Ribeiro Coca Parada; José Antonio Orellana Turri; Valery Helena da Costa; Ingrid Batista Vieira; Edmund Chada Baracat; José Maria Soares Júnior; Isabel Cristina Esposito Sorpreso

doi:10.1371/journal.pone.0282039

Peer Review History

Original SubmissionJune 7, 2022
14 Nov 2022 Decision Letter - Juan A López-Rodríguez, Editor PONE-D-22-10074Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2).PLOS ONE Dear Dr. Sorpreso, 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 Dec 29 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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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: I would like to thank you for the opportunity to review this manuscript. The study “Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2)” addresses an interesting and new topic aiming at analyze the sociodemographic and clinical factors and non-oncological gynecological diagnoses before and during the initial months of the COVID-19 pandemic in women that were assessed in a tertiary reference outpatient clinic. However, there are some issues that before publication should be solved. Please, find below my comments: Comments 1. The abstract is good, it brings the main information of the manuscript. 2. The introduction is well written, but I cannot identify a clear hypothesis. 3. The objective is correctly worded: clear and succinct and with specialized terms suitable for a general journal 4. The materials and methods described are appropriate to achieve the proposed objectives; are described clearly, completely, and succinctly to answer the proposed question. As for the data collection process and the instruments used, they are clearly described, but according to STROBE Statement we should report: - Inclusion criteria should be more detailed (women over 18 years of age?) - Bias: Describe any efforts to address potential sources of bias - Study size: Information on study size is separate. The calculation result is in the first sentence of the results section, it should be in the method. 5. Statistical analysis is adequate but according to STROBE Statement we should report “Explain how missing data were addressed” 6. Results are clear, appropriate, and correctly presented. The tables contain useful information and are arranged accordingly, but: - Table 1 appears to be missing information. Just below "Age at first intercourse" there are several "yes" and "no", but it's not clear where they belong. - Figure 1 is low resolution 7. It presents and discusses the points of convergence and divergence in relation to other authors. It mentions possible generalizations and/or practical applications or limitations from the results obtained. Criteria for Publication – Plos One 1. The study presents the results of original research: Yes 2. Results reported have not been published elsewhere: Ok 3. Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail: Yes 4. Conclusions are presented in an appropriate fashion and are supported by the data: Yes 5. The article is presented in an intelligible fashion and is written in standard English: I am not qualified to rate this question 6. The research meets all applicable standards for the ethics of experimentation and research integrity: Yes 7. The article adheres to appropriate reporting guidelines and community standards for data availability: There is no information on this issue ****** 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 ******** [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. Attachments Attachment Submitted filename: Review_PlosOne.docx https://doi.org/10.1371/journal.pone.0282039.r001
Revision 1
31 Jan 2023 Author Response Dear Editor PONE-D-22-10074 Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2). Fowling below answer to Reviewer #1 and Comments to the Author: Reviewer #1: I would like to thank you for the review of this manuscript. Please, find below our answer: Comments 1. The abstract is good, it brings the main information of the manuscript. Thank you. 2. The introduction is well written, but I cannot identify a clear hypothesis. The authors rewrite and included: “In gynecology, there is little information in the medical literature comparing the general demand for outpatient care before and during a pandemic [7]. In Brazil, the main gynecological diagnoses are menstrual disorders and abnormal bleeding from the female genital tract, inflammatory processes, and urogenital and breast disorders [8,9] and understanding the changes caused by the pandemic on women's healthcare services is important to support the appropriate decision-making in the management of health care and resources [5,10,11]. The characterization of the assisted population in the different levels of health services contributes to the quality of health care, which results in topics pertinent to women’s health in outpatient interdisciplinary training and fundamental points in the hierarchy of health services in which promotion and treatment measures are still incipient [11,12]. In addition, characterizing the assisted population and general prevalence rates of non-oncological gynecological diagnoses and the clinical factors involved are important, since the Brazilian Unified Health System works in a regionalized and equitable manner [12]. Thus, the objective of this study…..” 3. The objective is correctly worded: clear and succinct and with specialized terms suitable for a general journal We rewrite and modified: “analyze clinical factors and non-oncological gynecological diagnoses before and during the initial months of the COVID-19 pandemic.” 4. The materials and methods described are appropriate to achieve the proposed objectives; are described clearly, completely, and succinctly to answer the proposed question. As for the data collection process and the instruments used, they are clearly described, but according to STROBE Statement we should report: - Inclusion criteria should be more detailed (women over 18 years of age?) “The inclusion criteria were women over 18 years of age. The exclusion criteria were diagnoses of pregnancy, childbirth, puerperium, miscarriage, ectopic pregnancy, diagnosis related to trauma, and oncological diseases.” - Bias: Describe any efforts to address potential sources of bias. “Bias To address potential sources of bias, the authors included that all data from electronic medical records were extracted from the hospital database. In cases where a single patient presented with two or more diagnoses, each was described separately. When some information regarding a specific variable was not present in the hospital electronic database, the authors searched the complementary free fields for the missing values. Data were checked for consistency after data collection, and medical records were re-assessed (by LRCP and ICES) when there were discrepancies.” - Study size: Information on study size is separate. The calculation result is in the first sentence of the results section, it should be in the method. We rewrite and modified: “Study Size The optimal sample size required for this study was calculated considering the magnitude of minimal difference of 10%, using the proportion between the total number of patients in the period before and during the pandemic, with an alpha level of 0.05, and a minimum estimation power of 80% [13,14]. So, the sample sizes calculated for this study were 85 and 126, considering minimal differences of 10% and 1% in proportion, respectively, between the two periods of analysis.” 5. Statistical analysis is adequate but according to STROBE Statement we should report “Explain how missing data were addressed” We included: “The statistical analysis did not include all variables that present a greater number of missing data. When possible and clinically relevant, variables with a greater number of missing data were combined and included in the statistical analysis as multi-variables or grouped variables.” 6. Results are clear, appropriate, and correctly presented. The tables contain useful information and are arranged accordingly, but: - Table 1 appears to be missing information. Just below "Age at first intercourse" there are several "yes" and "no", but it's not clear where they belong. Thank you. We included the missing information and add all the variables. - Figure 1 is low resolution We change the figure 1 to a higher resolution. All authors agree to the answer and grateful for the comments. Best regards, Isabel. Attachments Attachment Submitted filename: PONE Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0282039.r002
7 Feb 2023 Decision Letter - Juan A López-Rodríguez, Editor Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2). PONE-D-22-10074R1 Dear Dr. Sorpreso, 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, Juan A López-Rodríguez Academic Editor PLOS ONE Additional Editor Comments (optional): 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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 answered all questions asked in the review. I consider a manuscript prepared for publication. ****** 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 ******** https://doi.org/10.1371/journal.pone.0282039.r003
Formally Accepted
14 Mar 2023 Acceptance Letter - Juan A López-Rodríguez, Editor PONE-D-22-10074R1 Non-oncological gynecological diagnoses in a women’s health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2. Dear Dr. Sorpreso: 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. Juan A López-Rodríguez Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0282039.r004

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