Sociodemographic and Clinical Factors That Influence Oral Health-Related Quality of Life in Adolescents: a Cohort Study.

OBJECTIVE: To determine the sociodemographic and clinical factors that may influence oral health-related quality of life (OHRQoL) at ages 12 to 15. BASIC RESEARCH DESIGN: Cohort study. PARTICIPANTS: Cluster-randomized sample of Hong Kong 12-year-olds. MAIN OUTCOME MEASURES: The Child Perceptions Questionnaire (CPQ11-14) was used to measure OHRQoL as the response variable. Periodontal status and caries were examined according to WHO criteria. Malocclusion was assessed using Dental Aesthetic Index. Potential predictors of OHRQoL (age, gender, father's education, mother's education, household income, periodontal status, caries, and malocclusion) were analyzed by structural equation modelling. RESULTS: At age 12, 589 participants (305 females, 284 males) were included. At age 15, 331 (172 females and 159 males) were followed up. For direct effects, age 15 was associated with higher oral symptoms (OS) scores (ß=0.124, 95%CI=0.049 to 0.2) but lower emotional well-being (EWB) scores (ß=-0.105, 95%CI=-0.184 to -0.03). Males had higher OS scores than females (ß=0.126, 95%CI=0.059 to 0.208). Mother's education had positive effects on children's EWB (ß=-0.096, 95%CI=-0.159 to -0.018). Malocclusion had negative effects on functional limitations (FL) (ß=0.083, 95%CI=0.013 to 0.186). For indirect effect, mother's education showed a link via EWB to OHRQoL (ß=-0.077, 95%CI=-0.123 to -0.018). Malocclusion showed a link via FL to OHRQoL (ß=0.037, 95%CI=0.006 to 0.087). CONCLUSIONS: Age, gender, mother's education and malocclusion predicted OHRQoL at ages 12 and 15.

Efficacy of caries and gingivitis prevention strategies among children and adolescents with intellectual disabilities: a systematic review and meta-analysis.

BACKGROUND: Dental caries and periodontal diseases are the most common oral diseases among human beings. Individuals with intellectual disabilities (IDs) have poor oral health and limited access to dental care. The aim of this study was to investigate the efficacy of strategies in caries and gingivitis prevention among children and adolescents with ID. METHODS: Four electronic databases (PubMed, Cochrane Library, Web of Science and Scopus) were searched from their commencement date to 17 April 2017. Randomised or non-randomised controlled trials evaluating the efficacy of interventions in caries and gingivitis prevention were included if the participants were children and adolescents with ID. Gingival index and caries experiences were reported in the format of mean difference and standard error. Meta-analysis was conducted if data could be pooled from two or more studies using similar outcome measurements and intervention. RESULTS: A total of 1455 articles published in English were identified. Fourteen studies formed the basis of qualitative analysis; six studies were feasible to perform quantitative analysis. Meta-analysis favoured fluoride to placebo in caries prevention [Z = 2.02, P < 0.05, 95% CI: -0.71 (-1.40, -0.02)], while the effectiveness of chlorhexidine remained elusive. CONCLUSIONS: Both mechanical and chemical approaches had been applied to caries and gingivitis prevention among children and adolescents with ID. Insufficient evidence supported the efficacy of chlorhexidine nor powered toothbrush, while fluoride was suggested to be an effective caries preventive strategy in fluoride-deficient areas. More well-designed randomised controlled trials using integration strategies are encouraged in further studies.

The effect of antiseptic oral sprays on dental plaque and gingival inflammation: A systematic review and meta-analysis.

OBJECTIVES: To review the effectiveness of antiseptic oral sprays on oral health. METHODS AND MATERIALS: Three electronic databases (PubMed, Cochrane Library and Web of Science) were systematically searched to identify relevant studies. Only randomized controlled trials (RCTs) comparing the effect of oral sprays to placebo/control spray or mouthrinse on dental plaque and gingival inflammation were included. RESULTS: Among a total of 996 papers, 20 effective studies fulfilled the selection criteria, and 8 studies were suitable for inclusion in meta-analyses. A meta-analysis of three studies using a 0.2% chlorhexidine (CHX) spray intervention, without prophylaxis at baseline, showed reductions in Plaque Index (PI) (Silness and Löe) and Gingival Index (GI) (Silness and Löe) scores of 0.74 (95% CI: -1.03 to -0.45) and 0.22 (95% CI: -0.38 to -0.06), respectively. Five studies provided a prophylaxis for subjects before study initiation. Three of these five studies used 0.2% CHX spray. A meta-analysis demonstrated an increase of 0.18 (95% CI: -0.01 to 0.37) in PI (Silness and Löe) scores. Two RCTs compared 0.12% and 0.2% CHX spray, and a meta-analysis showed increases of 1.71 (95% CI: 1.27 to 2.14) and 1.58 (95% CI: 1.23 to 1.93), respectively, in PI (Quigley and Hein) scores. Of the RCTs not amenable to meta-analysis, eight studies reported significant improvements in PI and GI scores. CONCLUSIONS: Available evidence suggests that oral sprays are an acceptable delivery method for antiseptic agents. Further high-quality studies are warranted to determine the effectiveness of alternative chemotherapeutic agents delivered via oral sprays on oral health.

Low-dose naltrexone: a novel treatment for Hailey-Hailey disease.

Hailey-Hailey disease (chronic benign familial pemphigus) is a rare inherited dermatosis typically characterized by erosions at intertriginous sites preceded by minor trauma or stress. We report a case of treatment-resistant Hailey-Hailey disease having failed topical and oral steroids, prophylactic aciclovir and doxycycline, and systemic therapies including dapsone, acitretin and ciclosporin. Low-dose naltrexone 4·5 mg once daily was commenced following an incidental benefit in this patient's similarly affected sister. The clinical and psychological response to date has been considerable.

A multi-centre randomised clinical trial of oral hygiene interventions following stroke-A 6-month trial.

Maintaining good oral hygiene is important following stroke. This study aimed to evaluate the effectiveness of two oral health promotion (OHP) programmes to reduce dental plaque levels following stroke. A multi-centre randomised clinical control trial was conducted among patients hospitalised following stroke in Malaysia. Patients were randomly allocated to two OHP groups: (i) control group who received the conventional method for plaque control-daily manual tooth brushing with a standardised commercial toothpaste, (ii) test group-who received an intense method for plaque control-daily powered tooth brushing with 1% Chlorhexidine gel. Oral health assessments were performed at baseline, at 3 months and 6 months post-intervention. Within- and between-group changes in dental plaque were assessed over time. Regression analyses were conducted on dental plaque levels at 6 months controlling for OHP group, medical, dental and socio-demographic status. The retention rate was 62.7% (54 of 86 subjects). Significant within-group changes of dental plaque levels were evident among the test group (P < .001) and the control group (P < .001). No significant between-group changes of dental plaque levels were apparent (P > .05). Regression analyses identified that baseline plaque levels (adjusted ß = 0.79, P < .001) and baseline functional dependency level (adjusted ß = -0.34, P < .05) were associated with dental plaques levels at the end of the trial (6 months). Both, "Conventional" and "Intense" oral health promotion programmes may successfully reduce dental plaque during stroke rehabilitation and are of comparable effectiveness. Baseline dental plaque levels and functional dependency level were key factors associated with dental plaque levels at follow-up at 6 months.

The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis.

BACKGROUND AND OBJECTIVES: Although low-level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its effectiveness as an adjunct to non-surgical periodontal treatment. This study aimed to evaluate whether an additional benefit exists for the application of LLLT compared with scaling and root planing (SRP) alone. MATERIAL AND METHODS: An extensive search was conducted in the Cochrane Library (Issue 8, 2015), PubMed (1997) and EMBASE (1947) before August 2015 for randomized controlled trials (RCTs). The bias risk was assessed with the Cochrane tool for risk of bias evaluation. A meta-analysis was performed using REVMAN 5.3. RESULTS: After independent screening of 354 initial records, eight publications (seven RCTs) were included. However, six were rated as 'having a high risk of bias' as a result of major methodological weakness in 'allocation concealment' and 'blinding of key personnel'. Meta-analysis showed that LLLT-mediated SRP demonstrated significant short-term benefits over SRP monotherapy in the improvement of the probing pocket depth (p = 0.0009 at 1 mo; p = 0.03 at 2 mo) and the level of interleukin-1ß in the gingival crevicular fluid (p = 0.01 at 1 mo). Nevertheless, LLLT failed to show significant additional intermediate-term (3 and 6 mo) effects in terms of clinical parameters and alveolar bone density. CONCLUSION: These findings indicated that LLLT showed only short-term additional benefits after conventional SRP. Its long-term effects remain unclear due to substantial methodological weaknesses and an insufficient number of current studies. Future RCTs with better designs and longer follow-up periods are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.

Oral health of Hong Kong children: a historical and epidemiological perspective.

OBJECTIVE: To provide a historical and epidemiological overview of the oral health of Hong Kong children. METHODS: Literature published before 2014 related to the oral health of Hong Kong children, supplemented with information accessed from government-archived oral health reports, was sourced using electronic databases and hand searches. Dental caries experience, periodontal health, enamel defects, and malocclusion of Hong Kong children were reviewed. RESULTS: A decline in the prevalence and extent of dental caries was observed among Hong Kong schoolchildren and adolescents after the 1960s. Among preschool children, however, dental caries remains common and the extent appears to have increased. The periodontal health of Hong Kong children remains unsatisfactory. Recently, enamel defects/dental fluorosis have considerably reduced. Information about malocclusion in Hong Kong children is limited. CONCLUSIONS: Since the 1960s, following public health policies, health promotion activities, and the introduction of a School Dental Care Service, improvements in the oral health of schoolchildren are evident. Nonetheless, the oral health of preschool children remains a concern. Policies and practices to improve the oral health of preschool children in Hong Kong are required.

Multiple tooth loss is associated with vascular cognitive impairment in subjects with acute ischemic stroke.

BACKGROUND AND OBJECTIVE: Emerging evidence shows that tooth loss is associated with cognitive impairment and dementia. Vascular cognitive impairment (VCI) is a common consequence of ischemic stroke. This study investigated the association of tooth loss with VCI in patients with acute stroke. MATERIAL AND METHODS: A total of 161 subjects with acute ischemic stroke were recruited. Within 1 wk after admission, fasting blood tests were undertaken and the number of teeth present was recorded. VCI was evaluated with the Montreal Cognitive Assessment (MoCA). RESULTS: The patients with loss of ≥ 8 teeth exhibited significantly lower MoCA values as compared to those with loss of ≤ 7 teeth (13.2 ± 6.6 vs. 17.3 ± 6.0, p < 0.001). Multivariate logistic regression analysis showed that loss of ≥ 8 teeth (OR = 3.1, 95% CI: 1.2-7.9, p = 0.02) and stroke history (OR = 3.8, 95% CI: 1.1-14.1, p = 0.04) were significantly associated with VCI (MoCA score ≤ 20.0). CONCLUSION: Within the limitations of this study, the current findings provide the first evidence that multiple tooth loss is independently associated with VCI in patients with acute ischemic stroke.

Orofacial functional impairments among patients following stroke: a systematic review.

OBJECTIVES: The objective of this study was to review orofacial functional impairments among patients following stroke, including objective and subjective assessment. METHODS: A structured search strategy was applied to three electronic databases (Pubmed, Embase, and Web of Science) to identify effective papers. Relevant data regarding subjects, method, outcomes, and key findings were extracted from the effective papers and the results were summarized. RESULTS: The initial search yielded 5227 papers, and 18 effective papers (Kappa: 0.971) were in accordance with the inclusion criteria. The patients with stroke consistently showed a decreased lip force, salivary flow rate, and chewing performance compared with the healthy controls. Due to equivocal results gained from the effective papers, the qualitative assessments regarding whether there was any change in masticatory force on the affected side and oral health-related quality of life were inconclusive. CONCLUSIONS: Existing evidence highlights a number of compromised orofacial functions experienced by patients following stroke. These impairments appear to be sustained, with spontaneous recovery unlikely to occur. While rehabilitative approaches may have the potential to improve orofacial function and quality of life following stroke, there is currently a lack of evidence-based interventions available to inform the development of comprehensive rehabilitation protocols.

Barriers to providing oral health care to pre-school children-differences between paediatric dentists' and general dental practitioners' beliefs.

BACKGROUND: The unmet dental needs of pre-school children indicate there are barriers in 'accessing' appropriate oral health care and this warrants consideration of care providers' beliefs. OBJECTIVE: To explore the beliefs and attitudes of dentists in Hong Kong towards providing oral health care to pre-school children; and to determine difference in attitudes between general dental practitioners (GDPs) and paediatric dentists (PDs). METHODS: A random sample of 476 GDPs (-25% of all registered dentists) and all registered PDs (28) were invited to participate in the study. Both groups were asked to complete the Barriers to Childhood Caries Treatment (BaCCT) questionnaire: a 29-item measure considering child, parent, dentist and health care system factors. Differences in attitudes of GDPs and PDs were examined in bivariate and regression analyses. RESULTS: The overall response rate of the study was 61.5% (310/504). There were significant differences in overall BaCCT scores and across all domains between GDPs and PDs (p < 0.05). Furthermore, variations across many aspects (as described at an item level) were apparent. Regression analyses confirmed differences in BaCCT between GDPs and PDs, controlling for practice and other factors. CONCLUSIONS: Differences exist between GDPs' and PDs' perceptions of barriers to care for early childhood caries. This has implications for how to address 'access' issues with likely implications on how to overcome barriers to care for pre-school children.

Development and evaluation of a Dental Patient Feedback on Consultation skills (DPFC) measure to enhance communication.

OBJECTIVES: To adapt an existing medical questionnaire on patient-provider communication for use in the dental setting, and to evaluate the performance of the measure in a first dental encounter (validity and reliability). METHODS: A patient feedback questionnaire on consultation skills was adapted for use in dental settings through content and convergent validity. A survey of dentist consultation skills was conducted among adults attending a teaching hospital. Patients self-completed a 16-item Dental Patient Feedback on Consultation skills (DPFC) questionnaire during their first dental consultations. Repeat assessments were conducted on -10% of the sample. Variations in DPFC responses (scale and item level) were examined in relation to socio-demographics and dental attendance pattern in bivariate and regression analyses. Internal reliability (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient - ICC) were examined. RESULTS: A DPFC questionnaire was derived following minor modifications. The clarity of items ranged from 81.1-100% and content validity index ranged from 0.73-1.00. Exploratory item factor analysis showed a one-dimensional construct. The response rate to the survey was 90.5% (389/430). Variations in DPFC scores with respect to global rating of satisfaction were apparent (P < 0.001). Cronbach's alpha value was 0.94 and ICC value was 0.89. Bivariate and regression analyses identified dental attendance pattern as a key factor associated with DPFC (P < 0.05); but no significant differences were observed with respect to socio-demographic factors. CONCLUSIONS: A DPFC questionnaire was adapted with acceptable validity and reliability. Dental service utilization pattern was associated with dentist-patient clinical communication rather than socio-demographics.

Spontaneous resolution of keratoacanthoma centrifugum marginatum.

Keratoacantnoma centrifugum marginatum (KCM) is a rare variant of keratoacantnoma, with > 40 cases reported world wide. Spontaneous resolution of KCM is very rare. To our knowledge, this is the first case of KCM with spontaneous resolution as documented by serial photographs.

Association between dental caries and adiposity status (general, central, and peripheral adiposity) in 12-year-old children.

BACKGROUND/AIMS: To investigate the cross-sectional relationship between dental caries experience and adiposity status (general, central, and peripheral adiposity) in 12-year-old children in Hong Kong. METHODS: A random sample of 668 12-year-old students was recruited. Clinical assessment for dental caries (DMFT) was conducted using WHO criteria. Anthropometric measurements for body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were performed to assess general adiposity (weight-height ratio, body mass index); central adiposity (WC; waist-hip ratio, WHR), and peripheral adiposity (TRSKF). Associations between adiposity indices and dental caries experience [prevalence DMFT > 0, 'high' experience (DMFT ≥ SiC Index value) and 'very high' experience (DMFT ≥ SiC10 Index value)] were examined in bivariate and multivariate regression analyses. RESULTS: The response rate was 76.9% (n = 514/668). Regression analyses (adjusted for oral hygiene practice, snacking habits, and socio-demographic factors) identified that WHR z score was associated with 'high' dental caries experience (OR 1.33, 95% CI 1.05, 1.70, p = 0.02), and that WHR z score was associated with 'very high' dental caries experience (OR 1.52, 95% CI 1.10, 2.11, p = 0.01). TRSKF z score was associated with 'very high' dental caries experience (OR 1.47, 95% CI 1.10, 1.96, p = 0.01). CONCLUSIONS: In a population-based sample of 12-year-old children in Hong Kong, dental caries experience was associated with adiposity. Central and peripheral, but not general adiposity was associated with dental caries experience.

What are the key endodontic factors associated with oral health-related quality of life?

AIM: To determine the associations between endodontic factors and oral health-related quality of life (OHQoL), controlling for socio-demographics, pain and other oral health clinical factors. METHODOLOGY: OHQoL assessments were conducted amongst a consecutive sample of 412 Chinese patients requiring endodontic treatment employing the short-form Oral Heath Impact Profile (OHIP-14). Information on (i) number of teeth requiring endodontic treatment, (ii) tooth type, (iii) retreatment requirements, (iv) periapical radiolucency assessment and (v) diagnostic classification was obtained. In addition, socio-demographic information (age, gender, educational attainment and family income), pain ratings on a visual analogue scale (VAS) and other clinical oral health status information were collected. RESULTS: Bivariate analyses identified association between number of teeth requiring endodontic treatment and summary OHIP-14 score (P < 0.01) and four of its seven domain scores (P < 0.05). Need for endodontic retreatment was associated with summary OHIP-14 score (P < 0.05) and two of its seven domain scores (P < 0.05). In regression analyses having controlled for socio-demographics, other clinical factors and pain rating amongst 15 confounding variables, patients requiring endodontic treatment for multiple teeth were more than twice as likely to have poor OHQoL (upper quintile OHIP-14 scores) compared with those requiring endodontic treatment for a single tooth (OR = 2.16, 95% CI 1.17, 3.98, P < 0.05). Pain VAS rating and age also emerged as significant factors associated with poor OHQoL in the regression analysis. CONCLUSION: OHQoL is compromised amongst patients requiring endodontic treatment. Number of teeth requiring endodontic treatment is associated with poor OHQoL, controlling for socio-demographic and other oral health clinical and pain factors.

The relationship between oral hygiene status and obesity among preschool children in Hong Kong.

OBJECTIVES: To explore the association between oral hygiene status and obesity among preschool children in Hong Kong. METHODS: Three hundred and twenty-four 5-year-old children in Hong Kong were recruited. Their oral hygiene status was recorded using visible plaque index (VPI). Body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were measured to assess general adiposity (weight/height ratio, W/H; body mass index, BMI), central adiposity (WC; waist/hip ratio, WHR) and peripheral adiposity (TRSKF). The relationships between VPI and W/H, BMI, WC, WHR and TRSKF were examined in bivariate and regression analyses. RESULTS: Fifty-six per cent of the children were considered to have high VPI (VPI ≥ 65.0%). Logistic regression analyses identified that W/H z-score (OR = 1.28, 95% CI = 1.01-1.61) and WC z-score (OR = 1.25, 95% CI = 1.00-1.58) were associated with high VPI. No association was found after adjusted for socio-demographic status (P > 0.05). CONCLUSION: Oral hygiene status was not associated with obesity among 5-year-old children in Hong Kong after controlling for socio-demographic factors.

Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders.

BACKGROUND/AIMS: Root caries among elderly communities is of growing public health concern globally. This controlled clinical trial investigated the effectiveness of silver diamine fluoride and oral health education in preventing and arresting root caries. METHODS: Two hundred sixty-six elderly subjects who had at least 5 teeth with exposed root surfaces and did not have serious life-threatening medical diseases were allocated to 3 groups according to a computer-generated random list: group 1 (the control group) received oral hygiene instructions (OHI) annually; group 2 received OHI and silver diamine fluoride (SDF) application annually, and group 3 was given OHI and SDF application annually, plus an oral health education (OHE) programme every 6 months. RESULTS: Two hundred twenty-seven elderly subjects were followed for 24 months. The mean numbers of new root caries surfaces in groups 1, 2 and 3 were 1.33, 1.00 and 0.70, respectively (ANOVA, p < 0.05). Group 3 had fewer root surfaces with new caries than group 1 (Scheffé multiple-comparison test, p < 0.05). The mean numbers of arrested root caries surfaces in groups 1, 2 and 3 were 0.04, 0.28 and 0.33, respectively (ANOVA, p < 0.01). Group 3 and group 2 had a greater number of active root caries surfaces which became arrested than group 1 (Scheffé multiple-comparison test, p < 0.05). CONCLUSION: Annual application of SDF together with biannual OHE was effective in preventing new root caries and arresting root caries among community-dwelling elderly subjects.

Agreement between periapical radiographs and cone-beam computed tomography for assessment of periapical status of root filled molar teeth.

AIM: To assess the agreement between periapical radiograph (PA) and cone-beam computed tomography (CBCT) for periapical assessment of root filled maxillary and mandibular molars. METHODOLOGY: Periapical radiograph and CBCT (iCat) images of 60 previously root filled molars (30 maxillary and 30 mandibular) were obtained at a review clinic. Agreement between PA and CBCT assessments of (i) number of canals per tooth, (ii) number of lesions per tooth, (iii) mesial-distal dimension of lesions, (iv) coronal-apical dimension of lesions and (v) presence of 'J'-shaped lesions were determined in comparison analyses and correlation analysis. RESULTS: There were significant differences between PA and CBCT assessment for the mean number of canals (P < 0.001) and periapical lesions (P < 0.001), mean mesial-distal (P < 0.001) and coronal-apical dimension of the lesion (if present; P < 0.001) and the mean number of 'J'-shaped lesions (P < 0.05). The magnitude of the statistical differences (or bias) was greater for maxillary than mandibular molars regarding the number and size of the lesions identified. Correlation values were weaker between PA and CBCT assessments of maxillary molars than for mandibular molars in all parameters assessed. CONCLUSION: There were substantial disagreements between PA and CBCT for assessing the periapical status of molar teeth, especially for the maxillary arch. The findings have implications in periapical diagnosis and for evaluating the outcome of endodontic care.

Journal-based learning, a new learning experience building on PBL at HKU.

OBJECTIVE: To evaluate the effectiveness of a new journal-based learning (JBL) programme designed to equip students with skills necessary to understand dental research publications, thereby preparing them for continuing professional development. MATERIALS AND METHODS: A baseline evaluation of knowledge relating to key research terms was conducted on 52 final-year BDS students. 11 weekly seminars were conducted from 8 clinical disciplines driven by a reading list of 2-5 journal articles along with a series of 'guidance' questions relating to research terms and content knowledge aspects of each paper to focus their reading and learning. Seminars were facilitated by discipline experts with supporting notes. An exit test based on research process and terminologies for the programme was conducted with 4 repeated questions from the baseline assessment. A systematic marking scheme was used and the results analysed. A focus group was run to collect feedback regarding students' views and experiences on the JBL experience. FINDINGS: Students showed significant improvements over the baseline score. The mean score rose from 3.5 to 11.5 in the repeated questions (P < 0.001). The focus group revealed that students had learnt new information about journal classification, evidence level determination, new research terms and the structure of research papers. From the first 4 years of PBL, students recognized the importance of learning from research papers since year 1. However, JBL gave them a deeper understanding of research and the development of critical appraisal skills. IMPLICATIONS: JBL provided final-year students the opportunity to learn significantly more about dental research, terminologies, paper structure, critical analysis and content knowledge through active-learning small group seminars.

Children, seen and heard: a descriptive study of all children (aged 12 years and under) referred for acute psychiatric assessment in Tallaght University Hospital over a 10-year period.

OBJECTIVES: A review of the literature demonstrates that relatively little is known about acute psychiatric presentations in children (0-12 years), compared with adolescents or young adults (12 years+). This study aims to review psychiatric presentations of children to a CAMHS Liaison Service at Children's Hospital Ireland (CHI) at Tallaght University Hospital over a 10-year period. METHODS: A retrospective study was undertaken of case notes of all children aged 12 years and under who were referred to the CAMHS Liaison Service between January 2009 and December 2018 (n = 318). Data were anonymised and inputted into SPSSv25 for analysis. The relationships between presentations and methods of self-harm over time were measured using Pearson's correlation. Associations between categorical variables were analysed using chi-squared tests. RESULTS: There was a significant increase in presentations of under-12s over the 10-year period (r(8)=0.66, p = 0.02). There was also a significant increase in children presenting with a disturbance of conduct and/or emotions over time (r(8) = 0.79, p < 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p < 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p < 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied. CONCLUSIONS: Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including suicidal thoughts and behaviours. There is a worrying trend in methods of self-harm, particularly in high lethality behaviours such as attempted strangulation.

Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study.

INTRODUCTION: Pacemaker implantation is the treatment of choice for clinically relevant bradyarrhythmias. Pacemaker-lead-associated thrombosis (PLAT) occurs in 23.0-45.0% of people with permanent transvenous pacemakers. Serious thromboembolic complications are reported in 0.6-3.5%. The incidence of PLAT in dogs is unknown. ANIMALS, MATERIALS AND METHODS: multicenter retrospective study of seven centers with 606 client-owned dogs undergoing permanent pacemaker implantation between 2012 and 2019. 260 dogs with a transvenous pacemaker with echocardiographic follow-up, 268 dogs with a transvenous pacemaker without echocardiographic follow-up and 78 dogs with an epicardial pacemaker. RESULTS: 10.4% (27/260) of dogs with transvenous pacemakers and echocardiographic follow-up had PLAT identified. The median time to diagnosis was 175 days (6-1853 days). Pacemaker-lead-associated thrombosis was an incidental finding in 15/27 (55.6%) dogs. Of dogs with a urine protein:creatinine ratio measured at pacemaker implantation, dogs with PLAT were more likely to have proteinuria at pacemaker implantation vs. dogs without PLAT (6/6 (100.0%) vs. 21/52 (40.4%), P=0.007). Urine protein:creatinine ratio was measured in 12/27 (44.4%) dogs at PLAT diagnosis, with proteinuria identified in 10/12 (83.3%) dogs. Anti-thrombotic drugs were used following the identification of PLAT in 22/27 (81.5%) dogs. The thrombus resolved in 9/15 (60.0%) dogs in which follow-up echocardiography was performed. Dogs with PLAT had shorter survival times from implantation compared to those without PLAT (677 days [9-1988 days] vs. 1105 days [1-2661 days], P=0.003). CONCLUSIONS: Pacemaker-lead-associated thrombosis is identified in 10.4% (27/260) of dogs following transvenous pacing, is associated with proteinuria, can cause significant morbidity, and is associated with reduced survival times.