Tuberculosis in Portugal: Intertwining History and Public Health Development

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Reviewer’s Comments and Suggestions for Authors

Journal: World, MDPI

Manuscript ID: world-3476436

Type: Review

Title: Tuberculosis in Portugal: Intertwining History and Public Health Development

Authors: Fabiana M. Ribeiro*, Pedro Soares, Teresa Rito and Ana Maria Silva

The authors of the review Manuscript ID: world-3476436 conducted bibliographic research across various academic databases and major Portuguese libraries, statistical archives, and public health repositories, and provided a more accurate history of Tuberculosis (TB) in Portugal based on the analysis of sanitary measures through time, illustrating the role of TB in the evolution of public health in Portugal. This research enhances our understanding of the past and sheds light on ongoing TB challenges

This review manuscript is interesting and written clearly and well. However, the resolution of Figures 1, 2, 3, 5, and 7 are low and the included words are vague. Also the X axis and Y axis are missing. Please clarify.

Lines 38-39: please provide the full names of the species: “three species of mycobacteria: M. africanum, M. canettii and M. tuberculosis (Mtb)”.

Line 183: “to urban spaces [20,48]. Due to...”.

Lines 258-260: please rephrase the sentence.

Lines 365-367: please rephrase the sentence.

Author Response

We appreciate the reviewer’s evaluation of our manuscript and acknowledgement of its strengths and areas for improvement. We have made significant enhancements, including improved resolution in Figures 1, 2, 3, 5, and 7. Additionally, as requested, we have included the full names of the species referenced in lines 38–39. The suggested revisions in lines 183, 258–260, and 365–367 have been implemented to ensure greater clarity and consistency throughout the text.

Reviewer 2 Report

Comments and Suggestions for Authors

There are some strenghts in the article:

Historical depth: The article traces the presence of tuberculosis in Portugal, drawing on archaeological finds and historical records. This depth highlights the long-standing public health challenge that tuberculosis poses.

Evolution of public health: By detailing the progress of public health initiatives, such as the establishment of the Instituto de Assistência Nacional aos Tuberculosos (IANT),

Cultural context: The discussion of the romanticization of tuberculosis during the 19th century and its depiction in literature and art provides a unique perspective on the social perception of the disease.

Weakness: Comparative Analysis: The article could benefit from comparing Portugal's TB situation with other Western European countries

Author Response

We appreciate the reviewer’s feedback and acknowledgment of the article’s strengths. We recognize that comparative analysis is essential. To this end, we have integrated Portugal’s experience with tuberculosis into the broader context of Western Europe and the United States. Specifically, we compare sanitation reforms in Portugal with those of France and England (lines 216-227), connect Portugal’s compulsory disinfection measures to contemporary initiatives in New York (lines 246-249), and demonstrate that while many European countries and the US experienced declines in tuberculosis mortality, Portugal continued to see an increase in these rates (lines 299-301).

Reviewer 3 Report

Comments and Suggestions for Authors

 Introduction section

From Line 99 to Line 104, the authors should clearly include the specific objectives of this study. Therefore, the authors should clearly articulate the specific objectives of this study. Each objective should be explicitly stated, aligning with the overall research aim and the significance of the study.

These objectives should delineate the key questions the study seeks to answer, the outcomes it intends to achieve, and the broader implications it aims to address.

Additionally, clearly defining the objectives will improve the manuscript’s coherence and offer the reader a better understanding of the study’s focus and direction [revise please] (Line 99 to Line 104)

 

Method section

From 105 to 115, the method and material description are clearly defined. In this section, it requires significant improvement to provide a comprehensive and detailed account of the processes and procedures utilized in this study.

The authors should elaborate on specific methodologies  (what type of methodology used and where has it been used (cite some references that have used it). For instance, using Bibliographic research using a narrative synthesis approach.

The study design should be clearly described, and the data collection techniques should be explicitly described.

Was there any sampling frameworks that this study emanated from? For instance, health belief model/framework used in public health to understand the behavioural components of individuals. Do you relate build this study based on any adapted or adopted framework?

The method section should be detailed to illustrate the strategic approach used. I strongly recommend that the authors urgently revise and expand this section to address these shortcomings effectively. [revise please]

 

Results

Can we have a separate paragraph for the results sections by using the specific objectives as the sub-theme headings.

The resolution of Figures 1, 2, and 3 is inadequate, resulting in blurry and unclear visuals that may hinder practical interpretation. The findings or information from the figures should be clearly stated in a concise narrative that reflects the sources and from the type of methodology you are using. I recommend that the authors enhance the resolution of these figures to ensure clarity and improve their overall quality. Please ensure the improved figures are appropriately labelled and formatted to meet the journal’s guidelines. [revise please]

The Authors may separate the discussion from the Results section. [revise please]

 

Discussion section

The Authors should have a separate discussion section based on the specific objectives that will act as a paragraph. [revise please]

 

Study’s Implications of Findings section

The authors should thoroughly discuss the implications of the findings presented in this study. This should include a detailed analysis of how the results contribute to the existing body of knowledge in the field, thereby highlighting the study’s novelty and relevance as this type of methodology employed in this study is different from the usual methods employed in other studies.

The potential impact on knowledge contributions, or future research should also be included in this section.

In addition, practical applications and recommendations from the findings should be articulated to demonstrate the study’s value in real-world scenarios. Providing these implications will enhance the significance and utility of the research for a wider audience. [revise please]

 

Recommendations section

The authors should clearly outline the recommendations arising from this study to provide actionable insights and guidance for stakeholders. These recommendations should be directly derived from the findings and address the key challenges or gaps identified in the study. They could include practical interventions, or areas for future research that would further enhance the understanding or application of the study’s outcomes. Additionally, the recommendations should highlight how the findings can be implemented in real-world contexts, offering tangible solutions to the issues under investigation. By doing so, the authors can effectively demonstrate their research’s broader impact and relevance to practitioners, policymakers, and the academic community. [revise please]

 

Proofreading and Editing section

The authors should carefully proofread and thoroughly edit the entire manuscript to enhance its quality and readability. This should address grammatical errors, typographical mistakes, formatting inconsistencies, and sentence structure or clarity issues. Attention should be paid to ensuring that technical terms are used accurately, arguments are presented cohesively, and all sections align with the journal’s formatting and submission guidelines. A meticulous proofreading and editing process from a Professional Editor will help to refine the manuscript, ensuring that it communicates the research findings effectively and meets the highest standards of academic writing. [revise please]

Comments on the Quality of English Language

The authors should carefully proofread and thoroughly edit the entire manuscript to enhance its quality and readability. This process should address grammatical errors, typographical mistakes, formatting inconsistencies, and sentence structure or clarity issues. Additionally, attention should be paid to ensuring that technical terms are used accurately, arguments are presented cohesively, and all sections align with the journal’s formatting and submission guidelines. A meticulous proofreading and editing process will help to refine the manuscript, ensuring that it communicates the research findings effectively and meets the highest standards of academic writing. [Kindly revise thoroughly]

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Author Response

We thank the reviewer for their constructive feedback, which has improved our manuscript. In the Introduction (Lines 99–104), we have clarified the study's objectives, aligning them with the overall research goal for better reader comprehension. The Methods section (Lines 105–115) has been revised to specify our bibliographic research approach with a narrative synthesis, addressing the comment regarding empirical data.

We are grateful for the suggestion to separate the Results and Discussion sections. However, considering the historical and interpretative nature of our study, we find that an integrated structure better supports the coherence and continuity of our analysis. We will address the figure resolution by replacing them with higher-quality versions that meet the journal’s guidelines. Although formulating practical recommendations isn't the study's main objective, we recognize their potential value for public health responses.

Reviewer 4 Report

Comments and Suggestions for Authors

The article provides a historical overview and brief statistics on the fight against tuberculosis in Portugal. The conclusions of the article are as follows: tuberculosis in Portugal cannot be defeated.
It should be noted that the article does not describe statistical data, does not conduct statistical tests, does not estimate the confidence interval for the predicted values.
The article lacks scientific novelty.

Author Response

Thank you for your feedback. While we value the reviewer's perspective, we have a different interpretation regarding the claims that our article "lacks scientific novelty" and asserts that "tuberculosis in Portugal cannot be defeated." We aimed to synthesize historical TB mortality trends in Portugal using digitized data, rather than focusing on predictive modeling or hypothesis testing.

While our article does not include formal statistical analysis, our contribution lies in consolidating and interpreting historical mortality data that has not been previously analyzed. This is vital for understanding TB's evolution in Portugal and sets the stage for future research. Importantly, the article does not claim tuberculosis cannot be defeated in Portugal; rather, it emphasizes TB's persistence over the past century and the complexities involved in its control, considering historical socio-political and public health factors