PONE-D-23-39925The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirthPLOS ONE

Dear Dr. Clark,

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 Mar 30 2024 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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We look forward to receiving your revised manuscript.

Kind regards,

Umesh Raj Aryal, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments:

In this study, the Author needs to explain the operational definition of Nulliparous students.

It is not easy to identify any nulliparous student who experienced miscarriages, abortion, or stillbirth. The author needs to explain "how they access this information from students.

Data were collected online and on paper both and also in English and Nepali. In this situation reliability and validity will be questionable how will you ensure it?

"high test-retest correlation (r=0.75) across six weeks". How many times survey were performed for this correlation? This information should be explained in the methodology.

Table 1 presents the chi-square test which is unclear about a demographic profile with PCS >=30 0r 20

There is only 1 other religion. can you define other?

Boarders in Tables 3 and 4 make it difficult to identify p values. It is unclear whether "χ 2-sided". Present exact p value at P<0.05 unless p is very small.

In table 5, age 2 has zero values. discuss it.

Explain the significance of logistic regression in this study. many variables are not associated with PCS score.

Some results in the table and text do not match. Needs to recheck and the odds ratio with a wide interval range is questionable. It is because of the sample size.

In overall methodology and analysis is not clear needs to improve it. Consult statistician.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

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

Reviewer #1: 1. It is better to put the line number in the manuscript to make easier for the reviewer.

2. Authors should make more clear and readable foe the following sentence in the Introduction:

In Nepal pain

catastrophising has been recognised as a characteristic that influences post-operative pain intensity

in addition it was reported that women were found to have significantly higher PCS scores than men

and a higher PCS was correlated with increases in requirements for pain relieving medication [25].

3. Authors should clarify following regarding Ethical Approval in Study Design and Participants section:

- How the Institutional Review committee at MMIHS could provide ethical approval to the study? Authors need to explain the responsibiity of the committee to clear the ethical approval for this study.

4. In Discussion section:

- The study additionally revealed that there is no significant relationship between a high PCS score (>30) and medication usage. The authors need to provide further elaboration on how these findings should be interpreted, particularly in connection with PCS scores exceeding 20 and their association with medication utilization.

Reviewer #2: Thank you very much for providing an opportunity for reviewing the article entitled “The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth”. The authors are grateful for providing the information about prevalence of pain catastrophizing in nulliparous women in Nepal. It is really interesting and new for Nepal. But there are some comments which are provided directly in the text as sticky note. The article has no any line numbers, hence difficult to indicate the comments in separate pages. The authors are suggested to improve their methods and be clear in the results and discussion sections. The articles may be accepted if the authors addressed all the comments provided in the MS directly. I recommend the major revision of the article.

Reviewer #3: 1. The topic selected is good but sample is too low to generalize it in context of Nepal. Only a college is selected in capital city of Nepal which also seems to be related to health science that often possesses a good knowledge and skill. As a prevalence study, it doesn’t indicate real status of women in colleges in local and peripheral especially rural area women. Neither can it present real status of Kathmandu only as the college selected is itself a private where usually students from a rich family background study pursue higher education. Authors are suggested to review topic or mention properly about this methodology portion.

2. Please give the rationale of selecting urban based private college which is itself a health science college. Why did you ignored the status of women of non-health science, public colleges and rural areas who usually are from back warded socio economic level.

3. It is better to place keywords in abstract in alphabetical order.

4. The study design selected seems to be cross sectional but the author has mentioned prospective. Please explain in detail about design adopted.

5. In a reputed journal like Plos one, use of proper statistical language for population and sample needs to be distinguished. The author has ignored such minor aspects.

6. Authors are advised to keep the meaning of other attributes in demographic and other information.

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Reviewer #1: Yes: Basant Adhikari

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: PONE-D-23-39925_R.pdf

Attachment

Submitted filename: Review recommendations.docx

Attachment

Submitted filename: Review 1.docx

PONE-D-23-39925R1The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirthPLOS ONE

Dear Dr. Clark,

Thank you for submitting your revised 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.

==============================

ACADEMIC EDITOR: 

Authors need to provide an operation definition of "nulliparous women"? Still an unclear reason for choosing nulliparous women in the introduction section.

How did you conform to normality? Just mentioning a histogram is not enough. Either present histogram or value of skewness.

Did the Author check the reliability of all three subscales?

In the Introduction, the objective of the study:

to explore the prevalence of pain catastrophizing in nulliparous women in Nepal and to identify predictors for pain catastrophizing.

In the Method Section, the aim of the study:

 to explore perceptions of pain rather than attitudes to menstruation.

These two statements look different. can you please clarify it?

The Pearson’s chi-square (χ2) test was used to test the difference in distribution between the categorical variables. What is the significance of using this study?

Participants’ PCS scores were not associated with age, ethnicity, or religion. Table is one way and explaining association. Please justify it.

There is no heading for Yes/No Response in Table 2. 

 6.39 [SD 2.39] (0-10)- remove SD 

Exp(B)- Different to understand to the reader who does not have a statistical background. Some values are zero. Please consult a statistician for logistic regression.  

95% Confidence interval- 1.933 to 8.419- replace to by -.The performance for the Logistic regression is unclear and just taking age and ethnicity. 

Consult a Statistician for data analysis.

In conclusion

"The study found a high prevalence of pain catastrophizing in young nulliparous women in Nepal". How studying one college represents Nepal. Next results are repeated in the conclusion. so the conclusion needs to be revised. 

==============================

Please submit your revised manuscript by Jul 07 2024 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,

Umesh Raj Aryal, PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

Authors need to provide an operation definition of "nulliparous women"? Still an unclear reason for choosing nulliparous women in the introduction section.

How did you conform to normality? Just mentioning a histogram is not enough. Either present histogram or value of skewness.

Did the Author check the reliability of all three subscales?

In the Introduction, the objective of the study:

to explore the prevalence of pain catastrophizing in nulliparous women in Nepal and to identify predictors for pain catastrophizing.

In the Method Section, the aim of the study:

to explore perceptions of pain rather than attitudes to menstruation.

These two statements look different. can you please clarify it?

The Pearson’s chi-square (χ2) test was used to test the difference in distribution between the categorical variables. What is the significance of using this study?

Participants’ PCS scores were not associated with age, ethnicity, or religion. Table is one way and explaining association. Please justify it.

There is no heading for Yes/No Response in Table 2.

6.39 [SD 2.39] (0-10)- remove SD

Exp(B)- Different to understand to the reader who does not have a statistical background. Some values are zero. Please consult a statistician for logistic regression.

95% Confidence interval- 1.933 to 8.419- replace to by -.The performance for the Logistic regression is unclear and just taking age and ethnicity.

Consult a Statistician for data analysis.

In conclusion

"The study found a high prevalence of pain catastrophizing in young nulliparous women in Nepal". How studying one college represents Nepal. Next results are repeated in the conclusion. so the conclusion needs to be revised.

[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.

The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth

PONE-D-23-39925R2

Dear Dr. Clark,

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.

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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,

Rabie Adel El Arab

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

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: (No Response)

Reviewer #2: Dear authors

Thank you authors for your hard work. All the comments addressed or answered technically. Authors should menimized the typo errors in this MS. I hope this articles will be baseline for the further research. Hence, I recommended for the publication.

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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: Yes: Basant Adhiari

Reviewer #2: Yes: Dr. Jagan Nath Adhikari

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