Physiological Stress Responses to Fear and Anxiety in a Height Change Experiment among Non-Labor Teenagers
Round 1
Reviewer 1 Report (Previous Reviewer 1)
GENERAL COMMENTS
Thank you for the opportunity to review your paper. The topic of the paper fits the scope of the Journal and has some novelty. However, there are some issues that should be addressed prior to publication.
SPECIFIC COMMENTS
Introduction
Lines 33-35: Please specify if you are talking for adult workers.
Methods
Lines 137-142: Could you please mention if the participants had any familiarization sessions with the application prior to the testing? If they did not, then the results could be affected.
Line 155: I would suggest that at line 155 instead of "the total time spent per experiment..."to say " the total time spent in each level..."
Line 159: I would suggest that in line 159 instead of "…, the completion time for 11 levels..." to say "…, the total time of the experimental protocol for all levels was 110 minutes..."
Line 177: Could you please mention the limits for small medium or large effect size?
Results
Lines: 250-251: Could you please consider rephrasing this sentence because it is a bit confusing. You could write something like " the most intense anxieties were rated at level 10, with score of 7 points, for females and at level 0, with score 3.50 points, for males.
Discussion
Lines 313-314: Please consider mentioning if the effect size is small medium or large, in my opinion it is essential information for the reader.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report (Previous Reviewer 3)
The authors propose to demonstrate the existence of associations between physiological responses, namely heart rate, blood pressure and reaction time with fear and anxiety in 15-18-year-olds when exposed to different levels of height.
Relative to previous versions of the manuscript, the authors have significantly improved the quality of the justifications for the decisions made. However, there appear to have been some problems (confounding factors) regarding the experimental design that influenced data collection and did not allow the objectives to be fully met. These factors should be identified and presented as limitations so that other authors can avoid them in future studies, thereby contributing to knowledge development.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report (New Reviewer)
The article lacks a clearly defined research goal(s), followed by precise answers to the question of whether the goal(s) have been achieved. The conclusions are only a repetition of the results of the research carried out. There is not even an outline of their application in practice. Writing that "heart rate, especially in relation to anxiety and fear, is an effective parameter for monitoring physiological changes in adolescents working at height", the authors should suggest how they envision such monitoring and taking into account heart rate in the younger population when working at height, e.g. on scaffolding or platforms.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report (New Reviewer)
I have read the revised version of the article. Authors' responses to reviews are satisfactory. I have no further comments and in my opinion the article in present form can be published.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
GENERAL COMMENTS
Thank you for the opportunity to review your paper. The topic of the paper fits the scope of the Journal and has some novelty. However, there are some issues that should be addressed prior to publication.
SPECIFIC COMMENTS
Title
In my opinion since the participants’ age in the present study is between 15-17 the authors should consider changing the term “children” with the term “teenagers” throughout the manuscript.
Introduction
Lines 28-33: In these lines you are providing some very important information about young workers who work at heights greater than 10 meters. But since your experimental protocol is based on work performed at maximum 10 meters, I think that you should provide some information about the number of teenagers that are currently working at heights below 10 meters and highlight why this study is need it.
Line 50: Please clarify what experiences you refer to. Do you mean when people are working at height?
Lines 52-54: Please rephrase this sentence. It is not clear what you mean. Do you mean that physiological stress could increase the heart rate, blood pressure and the reaction time?
Line 55: Please rephrase this as follows: "with variations in heart rate"
Lines 61-63: Please rephrase this sentence to make it clearer for the reader.
Participants
Line 74: Please consider providing a power analysis to determine if the sample size of your study was sufficient to detect statistical significance.
Lines 75-77: Please rephrase this sentence as follows: "Participants who were aged at least 15 years but not over 18 years old were included. All participants understood the aims of the present study and completed all tasks and assessments without missing data."
Measurements
Please provide information for the total duration of the experimental protocol.
Lines 82-83: Were participants wearing safety equipment (e.g., a safety harness)?
Line 84: Could you please indicate whether this process of tying/untying took place on the inside or outside of the metal staircase?
Lines 87-89: Could you please mention the time points that you performed these measurements (e.g., min 7, etc.)
Lines 90-93: Could you please provide more information about this procedure? For example, was each measurement BP taken in a sitting position or where were the hands held during the measurement (i.e., hands supported at the level of the heart)?
Lines 96-97: Could you please provide some information about the application? What is the name on the application or is it available online, etc.?
Lines 107: Could you please rephrase this sentence as follows: "...data were averaged...".
Lines 110-111: Why did you perform a non-parametric analysis? Did you perform a normality test and are the data not normally distributed?
Lines 113: Please explain why you used the nonparametric correlation.
Line 117: Could you please clarify the difference between r2 and R2?
Line 121: Please clarify in the text whether the results in the first table are mentioned at all levels.
Lines 136: In my understanding table 2 shows the differences between the sexes. Could you also provide data for comparisons between levels (i.e., level 1 vs. level 2 vs. 3, etc.)?
Lines 138-139: Please correct this typo. In my understanding the higher values apply to the female group, not the male.
Line 3: In my understanding table 3 shows the differences between the sexes. Could you also provide data for comparisons between levels (i.e., level 1 vs level 2 vs 3 etc.).
Discussion
Lines 82-84: Could you please explain further why the female group in level 0 had the highest anxiety and fear scores? Did you have any familiarization sessions? If not, could this score be due to the anxiety and fear they felt before starting the experiment?
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 2 Report
Dear
The present study shows the physiological responses of young participants exposed to different heights. in the method section of the article should it be mentioned that the participants fill out the consent form in the study.
My review shows that the study and article are completely, comprehensively, and accurately written and no problems were found in it. And therefore it is suitable for publication in the safety journal.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
The manuscript proposes to find an answer to prevent falls from heights, particularly in young people. To this end, the authors propose to demonstrate the existence of associations between physiological responses, namely heart rate, blood pressure and reaction time with fear and anxiety in young people (15-18 years old), when exposed to different height levels (0-10 m)
However, there seem to have been some problems (confounding factors) regarding the experimental design that influenced the variables and did not allow the objectives to be met.
Authors should pay more attention to the following issues:
1- The justification for the different parameter options should be better justified through a more developed literature review. The use of controversial parameters such as reaction time must be better substantiated.
2- A more detailed explanation is also needed on how blood pressure and heart rate were measured.
3- In the results presented in table 2, although the relationships between males and females are found, no clear tendency is shown concerning the variation of the parameters with height, despite all the elaborate statistical treatment.
4- The conclusions do not respond to the objectives, which focus on physiological changes and the occurrence of fear and anxiety with height. They only suggest heart rate monitoring. A conclusion that could be the same in countless other situations.
5- Additionally, the whole experiment should also be better explained so that it can be reproduced, including which confounding factors were identified and how they were minimised.
-6- A chapter on work limitations would also be important,
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
GENERAL COMMENTS
The authors did a great job and have addressed almost all of my suggestions and the article has been significantly improved since the last version. However, there are some further issues that need it to be addressed
SPECIFIC COMMENTS
Methods
Lines 145-150: Based on the latest information you provided for the revised version of the paper I understand that the total duration of the experiment was 110 minutes. Since you had 10 levels and you performed all the tests (BP, HR, reaction time, fear, and anxiety) in each level and the duration of all the measurements in each level was 10 minutes, so 10 minutes * 11 levels (0,1,2...10), giving a total duration of 110 minutes. Is this correct? If so, please correct this, otherwise please state how long the entire experiment lasted.
Results
The aim of your study was “to examine the relationships between physiological responses, fear, and anxiety in a constructed environmental setting among Thai teenagers who had never worked at heights” Based on this aim I think that it is really important to perform some analysis investigating the potential differences in the physiological and subjective data between levels. Otherwise, you should change the aim of your study saying that the aim was to investigate potential differences between sexes.
Discussion
Lines 63 66: Could you please mention for which gender you present the results in these lines, is it still for both genders? Since you are mentioning to higher and lower heart rate, you should perform an analysis to investigate if there are statistically significant difference in heart rate between the levels, or do an effect size analysis to exam if these differences you have shown are small, medium or large. If these differences are small, you should mention that and then you should consider whether there is an effect of height on physiological parameters in teenagers.
Lines 69-70: Please consider rephrase this sentence and mention that there was a statistically significant difference between males and females with the girls having higher heart rate at all levels. Then it will make more sense why it was more difficult for girls compared to the boys.
Line 83: Please specify if the correlation was weak moderate or strong
Lines 94: Could you please rephrase this sentence "despite the fact that their sex was controlled"? I am not sure I understand what you mean
Reviewer 3 Report
Answer to 1st question - Justification of the parameters used -Lines 69-73 -
Only one reference was added and the main question was not answered. No justification for the use of "reaction time" was added. The added reference ([21]) makes no mention of this issue.
Answer to 2nd question - Methodology - Lines 116-124 -
Since the aim is to measure blood pressure and heart rate in conditions of fear and anxiety in order to establish a relationship between these parameters, it does not make sense to ask the subject to relax before taking this measurement.
Answer to 3rd question - Results -
In the tables it is not clear what the numbers inside and outside the parentheses mean.
Answer to 3rd question - Results - Page 9, Lines 62-70
A description of the results is presented, but no tendency is demonstrated in their evolution. Therefore, there is no evidence of any relationship between the results and the variation in height to which the subject is exposed.
