PONE-D-22-23328Cardiovascular risk factors among nurses: A global systematic review and meta-analysisPLOS ONE

Dear Dr. Ghashghaee,

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.

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Dear, the systematic review with meta-analysis presents some methodological issues that need adjustments. Especially, about the publication of a protocol of systematic review and meta-analysis. Try registering with Prosper or OSF. Additionally, it has methodological and results-related comments that need to be rigorously corrected so that the article can be considered for publication.

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Please submit your revised manuscript by Dec 01 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 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Ana Claudia Morais Godoy Figueiredo, Ph.D

Academic Editor

PLOS ONE

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At this time, please address the following queries:

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Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

4. 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.

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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

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

Reviewer #1: I Don't Know

Reviewer #2: 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: Yes

Reviewer #2: No

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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

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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: Some major and minor comments should be addressed before its publication.

The introduction is good. However, it is better for you to use more recent references in this field. For example, you can add the following two references to lines 4 and 11, respectively.

Shmakova NN, Puzin SN, Zarariy NS, Abol АV. THE CHARACTERISTICS OF THE IMPAIRED FUNCTIONS AND LIFE LIMITATIONS OF THE DISABLED PEOPLE DUE TO THE CORONARY HEART DISEASE. Journal of Population Therapeutics and Clinical Pharmacology. 2022 Mar 15;29(01).

Randhawa H, Ghaedi Y, Khan S, Al-Sharbatti S. The prevalence of overweight and obesity among health care providers in the emirate of Ajman, UAE. Journal of Complementary Medicine Research. 2020 Sep 25;11(3):40-.

It does not appear that a protocol has been pre-registered for this review (eg in PROSPERO). This is a concern as it introduces potential bias to the review and does not align with Cochrane's guidance. The authors should note that a protocol was not registered, and discuss it as a limitation in the discussion.

Pub Med? Please check the entire text of the manuscript in terms of writing

I suggest the author provide the full electronic search strategy for at least one database, including any limits used, such that it could be repeated, as a supplementary file.

Data screening and selection should have kappa statistics between the authors.

The authors can conduct a "snowball search" to add other articles (missing from this study).

I note the authors have reported results according to the PRISMA checklist. Please include a copy of the PRISMA checklist (with page numbers noted for each section) as a supplementary appendix, as required by PRISMA.

Results were duplicated in the text and tables/figures. I suggest avoiding any duplication to improve the readability of the manuscript.

I suggest an extensive revision of the discussion with more explanation of the results of the current study. In discussion, many factors could have influenced the results. Please also discuss other factors.

Reviewer #2: I am glad for the opportunity to review this manuscript. The theme of this systematic review is relevant.

I hope some questions and comments below may contribute to refining the paper.

Abstract

#1 – Objectives – In the last sentence, the authors should provide a more explicit statement of the study's primally objective (preferably with reference to PICOS or one of its variants)

#2 – Methods – The authors should specify the inclusion and exclusion criteria for the review and language restrictions.

#3 – Methods – The Newcastle-Ottawa Scale for quality assessment and the risk of bias assessment should be stated in the Methods.

#4 – Results – The results for family history of cardiovascular disease (41.9%; 95% IC: 29.8-55.1%), being overweight (33.3%; 95% IC: 24.7-43.2%), and alcohol consumption (24.6%; 95% IC: 16.4-35.2%) should be present since they are among the most prevalent risk factors in the study.

#5 – Result – Regarding systemic blood pressure, the authors should present the prevalence of systemic arterial hypertension instead of the mean systolic and diastolic blood pressures if they consider it a key study finding.

#6 - Results – The authors should provide a brief summary of the limitations of the evidence included in the review, such as the quality of the evidence and the risk of bias, inconsistency, and imprecision.

#7 – Conclusion – In addition to the general interpretation of the results and significant implications, the authors should present the main conclusions related to the study objective.

#8 – Did the authors previously register the study? If yes, the authors should provide the registered name and registration number in the Abstract and the main text.

Background

#1 – Are other systematic reviews addressing the cardiovascular risk factors among nurses? If yes, the authors should explain how the current systematic review can add to the acknowledgment from the previous studies.

#2 – In the last paragraph, the authors should provide a more explicit statement of the questions and objectives being addressed (preferably with reference to PICOS or one of its variants).

Methods

#1 – The literature review search period and the last search date should be stated in the first paragraph of the Methods.

#2 – The text presented in the 'Databases and search terms" should be split into separate headings, such as Study design and registration, Search strategies for identification of studies, Data collection and analysis, and Data extraction and management.

#3 – The authors should consider showing the complete search strategies for all databases, including any filters and limits used, in the Supplementary Material.

#4 – The authors should consider including a table summarizing the inclusion and exclusion criteria using the study characteristics (e.g., participants, setting, target condition(s), and study design) and report characteristics (e.g., years considered, language, and publication status).

#5 – The working definition for behavioral, biological, and physical risk factors should be presented in the Methods.

#6 – Why did the authors include only articles in English?

#7 – The study selection process should be described in more detail: the duplicate screening, title and abstract screening, and full-text articles assessment for relevance. Did a reference management software package or a screening and data extraction tool be used to screen for duplicates and study selection?

#8 – The risk of bias assessment should be stated in the Methods

#9 – The authors should indicate whether a review protocol exists and, if yes, the registered name, registration number, and where it can be accessed (e.g., Web address) in the Methods.

#10 – Figure 1 – The number of studies excluded for each criterion should be shown.

Results

#1 – In the text, before splitting into behavioral, biological, and physical risk factors, the authors could present the results of all cardiovascular risks together.

#2 – The authors should present the results of the meta-analysis as forest plots, including the heterogeneity test (I2).

#3 – Tables – Please correct the p-values that cannot be 0.000 (insert p < 0.001 instead p = 0.000).

#4 – Tables – The full form of abbreviations should be presented in the footnote.

#5 – Table 1 – The study's characteristics should include the study design/type.

Finally, I did not thoroughly check for grammatical errors since I am not a native English user. An appropriate language reviewer should do this.

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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

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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.

PONE-D-22-23328R1Cardiovascular risk factors among nurses: A global systematic review and meta-analysisPLOS ONE

Dear Dr. Ghashghaee,

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 22 2023 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,

Patricia Khashayar

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.

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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

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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: I thank the authors for the sufficient answers to the previous comments. In my opinion, the study is clear and can be suitable for publication

Reviewer #2: Thank you for responding to the comments from all reviewers and resubmitting your work. The authors have made appropriate adjustments to the original submission, and the manuscript has improved from the feedback from the reviewers. I have only a few comments/suggestions regarding the Abstract Section to enhance your manuscript further:

The key inclusion and exclusion criteria for the review and language restrictions should be stated in the Abstract Methods.

The Newcastle-Ottawa Scale for quality assessment and the risk of bias assessment should be stated in the Abstract Method.

Regarding the risk factors, family history of cardiovascular disease (41.9%; 95% IC: 29.8-55.1%), being overweight (33.3%; 95% IC: 24.7-43.2%), and alcohol consumption (24.6%; 95% IC: 16.4-35.2%) should be present in the Abstract Results since they are among the most prevalent in the study.

The authors should summarize the limitations of the evidence included in the review, such as the quality of the evidence and the risk of bias, inconsistency, and imprecision in the Abstract Results.

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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

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[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.

Cardiovascular risk factors among nurses: A global systematic review and meta-analysis

PONE-D-22-23328R2

Dear Dr. Ghashghaee,

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,

Patricia Khashayar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: