Background/Aims: The standard of care for older patients with oropharyngeal dysphagia (OD) is poor. Stimulation of transient receptor potential vanilloid 1 might become a pharmacological strategy for these patients. This study aimed to compare the therapeutic effect of film food containing 0.75 µg of capsaicin in these patients. Methods: In a crossover, randomized trial, 49 patients with OD were provided capsaicin or identical placebo at least 7 days apart. Patients' reported symptoms during repeated swallowing, the volume, pH and substance P (SP) concentrations in saliva, and cervical esophageal wall motion evaluated by ultrasonographic tissue Doppler imaging were obtained before and after capsaicin or placebo administration. Results: Significantly more patients with OD who took capsaicin experienced improvement in symptoms than those who took placebo. Salivary SP levels were significantly increased after capsaicin administration compared with placebo in the effective group. The duration of cervical esophageal wall opening was significantly shorter in capsaicin administration in the effective group. Furthermore, a significant negative correlation was found between the duration of cervical esophageal wall opening and salivary SP levels. Conclusion: Elevated salivary SP concentrations stimulated by capsaicin greatly improve the safety and efficacy of swallowing, and shorten the swallow response in older patients with OD.

More attention should be placed on drinking in the cultural context where a disaster occurs. It may sometimes deter, rather than encourage, drinking among the affected population.

In June of 2002, a revision to part of the Road Traffic Act drastically increased the penalties for drinking and driving offences in Japan. Most notably, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 mg/ml to 0.03 mg/ml. The rationale for the new lower BAC limit was predicated on the assumption that drinking drivers will comply with the new, lower limit by reducing the amount of alcohol they consume prior to driving, thereby lowering their risk of crash involvement. This, in turn, would lead to fewer alcohol-related crashes. A key limitation of previous lower BAC evaluation research in determining the effectiveness of lower legal BAC limit policies is the assumption of population homogeneity in responding to the laws. The present analysis is unique in this perspective and focuses on the evaluation of the impact of BAC limit reduction on different segments of the population. The chief objective of this research is to quantify the extent to which lowering the legal limit of BAC has reduced male, female and teenager involvement in motor vehicle crashes in Japan since 2002. Most notably, the introduction of reduced BAC limit legislation resulted in a statistically significant decrease in the number of alcohol-impaired drivers on the road in Japan, indicating responsiveness to the legal change among adults and teenagers. In addition, this preliminary assessment appears to indicate that the implementation of 0.03 BAC laws and other associated activities are associated with statistically significant reductions in alcohol-involved motor vehicle crashes. In comparison, the rates of total crashes showed no statistically significant decline nor increase in the period following the introduction of the BAC law, indicating that the lower BAC limit only had an effect on alcohol-related crashes in Japan. The evidence suggests that the lower BAC legal limit and perceived risk of detection are the two most important factors resulting in a sustained change in drinking and driving behaviour in Japan. It is recommended that future research and resources in other countries be focused on these factors as determinants to reduced alcohol-related crashes.

Objective: To determine the relationship between electrode position and hyoid movement for effective surface electrical stimulation in the treatment of dysphagia. Methods: Surface electrode pairs targeted on the suprahyoid muscle group were placed in mesial, distal, or pervasive placement patterns on the skin anterior to the suprahyoid muscle group of five healthy subjects, and the vertical and horizontal movements of the hyoid induced by electrical stimulation in the three pattern groups were measured and compared. Results: The mesial electrode-pair pattern induced significant anterior movement of the hyoid. The distal pattern showed a tendency to induce upward hyoid movement. The distance of hyoid movement induced by the electrical stimulation was about half of that found for actual water swallowing. No significant difference in electrical stimulus intensity was found among the electrode patterns. Conclusion: Surface electrical stimulation with mesial electrode-pair placement anterior to the hyoid presumably induces contraction of the digastric muscle anterior belly and the geniohyoid muscle, and was found to pull the hyoid forward. This information and further elucidation of the relationship between surface electrode position and hyoid movement is expected to increase the range of clinical applications.

Objective: Ultrasonography can be used to assess both the morphology and movement of the muscles of deglutition. This study investigated the intratester, intertester, and retest reliability of ultrasonic assessments of the suprahyoid muscle group. Methods: Three testers performed ultrasonographic measurements of the length and area of the geniohyoid muscle in 10 healthy adults, and the contraction ratio during swallowing. Results were compared using intraclass correlation coefficients (ICCs) to determine intratester, retest, and intertester reliabilities. Results: Intratester and retest reliabilities were very good, with ICCs ≥0.8 for all assessment parameters. In intertester reliability, ICCs were ≥0.8 for geniohyoid muscle length and area during swallowing and ≥0.6 for geniohyoid muscle length at rest and contraction ratio. Discussion: These results indicate high reliability of this assessment method for assessments made by the same individual, with reliability of the method remaining high for assessments performed at intervals.