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This study examined whether the number of options in the Likert scale influences the psychological distance between categories. The most important assumption when using the Likert scale is that the psychological distance between options is equal. The authors proposed a new algorithm for calculating the scale values of options by applying item response theory and the ideas of Wakita to reveal the influence of the number of categories. Three types of questionnaires that were composed of the same items, but used different numbers of options to assess these items (specifically, 4-, 5-, and 7-point scales), were completed by 722 undergraduate students. The results indicated that the number of options influenced the psychological distance between options, particularly for the 7-point scale. This influence was revealed only by the authors’ algorithm; descriptive statistics and coefficients of reliability did not show that the number of options had a prominent influence. The importance of the number of options and the new algorithm are discussed.

BackgroundFew studies have examined the prevalence of lumbar spinal stenosis (LSS) in the general population. The purposes of this study were to estimate the prevalence of LSS and to investigate correlated factors for LSS in Japan.MethodsA questionnaire survey was performed on 4,400 subjects selected from residents aged 40–79 years in Japan by stratified two-stage random sampling in 2010. The question items consisted of lower-limb symptoms suggestive of LSS, the diagnostic support tool for LSS (LSS-DST), demographic and lifestyle characteristics, comorbidities, the Japanese Perceived Stress Scale (JPSS), and the Mental Health Index 5 (MHI-5). Using the LSS-DST, the presence of LSS was predicted to estimate the prevalence of LSS. Logistic regression analysis was performed to examine the relationship between LSS and correlated factors.ResultsQuestionnaires were obtained from 2,666 subjects (60.6 %), consisting of 1,264 males (47.4 %). The mean (standard deviation) age was 60.0 (10.9) years. According to the LSS-DST, 153 subjects were regarded as having LSS. The prevalence was estimated to be 5.7 %. When standardizing this value with the age distribution of the Japanese population, it was estimated that 3,650,000 Japanese subjects aged 40–79 years might have LSS using the LSS-DST. Prevalence increased with age and was particularly high in subjects aged 70–79 years, irrespective of gender. As correlated factors, an advanced age (60 years or older), diabetes mellitus, urological disorders, and osteoarthritis/fracture as comorbidities, and depressive symptoms, were associated with LSS.ConclusionsThis study elucidated the prevalence of LSS and factors associated with LSS in Japan. This is the first report describing the estimated prevalence of LSS and associated factors using a strictly sampled representative population.

The results of the psychometric analysis indicated that the QoR-40J has characteristics of acceptable validity, reliability, and responsiveness in clinical practice in Japan. The QoR-40J may aid in evaluating the quality of recovery after surgery or the quality of methods of anesthesia.

Personality scales based on the five-factor model, especially the big-five scale of personality trait adjectives (Wada, 1996), are commonly used in Japan. In this study a short form of the Big-Five Scale was constructed. To avoid changes in the capacity dimension caused by the decrease in the number of items, item selection was conducted after item response theory (IRT) scales were constructed for all the items. In study 1 data was collected from 2099 participants. A generalized partial credit model was applied to the IRT model, and items were selected using the slope and location parameters for each item. Cronbach's alpha showed that the short form, as well as the five sub-scales, had sufficient reliability as a personality test. In study 2, we determined correlations with the NEO-FFI and tested the concurrent validity of the short form. The results indicate that the short form of big-five scale demonstrates sufficient reliability and validity despite the reduced number of items.

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Background A family member’s negative experiences with medical care have long-term effects on a patient’s attitudes and emotions. However, the impact of family members’ experiences on patients’ trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations. Methods A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients’ (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit. Results The results showed a lower rating for trust in physicians generally as compared to trust in the respondent’s personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member’s medical care was associated with lower trust in physicians generally (mean difference − 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member’s care was also associated with lower trust in the respondent’s personal physician (mean difference − 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally. Conclusions We suggest that physicians enquire about past patients’ negative experiences, including dissatisfaction with family members’ medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.