Pharmacokinetics, safety, and tolerability of fosmanogepix IV to oral switch and multiple IV doses in healthy participants.

Fosmanogepix [FMGX, APX001; active form: manogepix (MGX), APX001A] is a first-in-class, intravenous (IV)/oral antifungal currently being evaluated for invasive fungal disease treatment. Data from two phase 1, placebo-controlled studies [IV-oral switch (study 1) and multiple IV doses (study 2)] evaluating FMGX tolerability, and pharmacokinetics (PK) are presented. Healthy adults (study 1: 18-65 years; study 2: 18-55 years) were eligible (randomized 3:1 to FMGX: placebo). Eleven participants completed study 1. In study 2, 51 participants (48 planned + 3 replacement) were enrolled in six cohorts (8 participants each; 34 completed the study). In study 1, overall MGX systemic exposures were comparable from day 1 to day 42 of dosing; steady-state plasma concentrations were achieved in ≤24 h following two IV loading doses (1,000 mg) and exposures maintained after switching [IV (600 mg) to daily oral doses (800 mg)]. FMGX was safe and well-tolerated. In study 2, FMGX IV doses (loading doses twice daily/maintenance doses once daily; 3-h infusion) of 1,500/900 mg (cohort A), 900/900 mg (cohort B), and 1,000/900 mg (cohort C: with ondansetron) were not well-tolerated; most participants reported nausea and infrequent vomiting. FMGX IV doses of 1,000/750 mg (cohort D), 1,000/850 mg (cohort E), and 1,000/900 mg (cohort F: ondansetron prn) were relatively better tolerated. Steady-state systemic exposures were achieved between days 2 and 4. All cohorts had similar geometric mean (GM) concentrations during maintenance dosing and similar GM PK parameters. Dosing regimen evaluated in study 1 was safe, well-tolerated, and may be used for future clinical evaluations.

Guardians' perceptions of caring for a dog with canine cognitive dysfunction.

BACKGROUND: Canine cognitive dysfunction (CCD) is a neurodegenerative disease that is difficult to diagnose, as its clinical signs are similar to those of other age-related conditions. The experience of caring for a senior dog with or without CCD is not well described. METHODS: Data were collected via an online survey. Using a mixed methods design, the level of CCD and burden of care were measured using validated tools, and open-ended questions gathered qualitative data. A general linear model showed the factors associated with guardian burden of care. RESULTS: Sixteen percent of guardians experienced a clinically significant burden of care. Factors associated with burden of care included severity of CCD, sleep location, guardian employment, household size, dog age, guardian age and the dog taking medication. Few dogs with CCD were prescribed CCD medications to ameliorate clinical signs. Euthanasia, strong attachment mitigating burden and the complexities of caregiving were themes presented by guardians. LIMITATIONS: Measures are based on self-reports and as such the usual limitations apply. CONCLUSIONS: The burden of caring for an older dog is greater if they have CCD. More attention to the treatment of senior dogs, including medications to reduce clinical signs of CCD, could improve the welfare of older dogs and decrease the clinical burden experienced by guardians.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting.

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

The moral deliberation pathway in veterinary practice: a qualitative study.

BACKGROUND: Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised. METHODS: Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians. RESULTS: The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort. LIMITATIONS: Self-selection of participants and possible recollection bias may have biased the findings. CONCLUSIONS: The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.

Understanding the Role of Therapy Dogs in Human Health Promotion.

Dogs may provide humans with a range of physical, mental and social benefits. Whilst there is growing scientific evidence of benefits to humans, there has been less focus on the impact to canine health, welfare and ethical considerations for the dogs. The importance of animal welfare is increasingly acknowledged, indicating that the Ottawa Charter should be extended to include the welfare of non-human animals supporting the promotion of human health. Therapy dog programmes are delivered across a variety of settings including hospitals, aged care facilities and mental health services, highlighting the important role they play in human health outcomes. Research has shown that that there are biomarkers for stress in humans and other animals engaged in human-animal interactions. This review aims to assess the impact of human-animal interactions on therapy dogs engaged in providing support to human health. While challenging, it is paramount to ensure that, within the framework of One Welfare, the welfare of therapy dogs is included, as it is a key factor for future sustainability. We identified a range of concerns due to the lack of guidelines and standards to protect the wellbeing of the dogs engaged in these programmes. Extension of the Ottawa Charter to include the welfare of non-human animals with leveraging through a One Welfare approach would promote animal and human health beyond current boundaries.

The Impact of the Social Determinants of Human Health on Companion Animal Welfare.

The social determinants of health (SDH) focus on the social, physical and economic factors that impact human health. Studies have revealed that animal guardians face a range of challenges in attaining positive welfare outcomes for their companion animals, which can be influenced by socioeconomic and environmental factors. Despite this, there is a lack of research specifically exploring the relationship between SDH and animal welfare outcomes. Given that the SDH impact on humans, which in turn directly impacts on their companion animal, it is important to adapt an SDH framework for companion animal welfare by characterising the impact of the SDH on companion animal guardians in their attempts to care for their animals and, by extension, the associated welfare outcomes. This paper explores how these human health determinants may impact animal welfare and the possible challenges that may arise for the guardian when attempting to meet their companion animal's welfare needs. By integrating the SDH with other key frameworks, including the five domains model of animal welfare, through multidisciplinary collaboration, this framework can be used to inform future programs aiming to improve animal welfare.

Cats just want to have fun: Associations between play and welfare in domestic cats.

Play is often considered an indicator and promotor of animal welfare and may facilitate closer cat-human relationships. However, few studies have empirically investigated these associations. The current study aimed to investigate play-related factors associated with four welfare outcome measures in cats (Felis catus) including: cat quality of life; cat-guardian relationship quality; problem behaviour prevalence; and behavioural changes. An online survey was developed using demographic information, questions related to play and resources, free text sections and the following validated measures: cat quality of life (QOL), the cat owner relationship scale, and the adult playfulness trait scale. Responses were completed by 1,591 cat guardians from 55 countries. Higher cat playfulness scores and a greater number of games played were significantly associated with higher cat QOL scores while longer amounts of daily play, greater number of games, both cat and guardian initiating play and higher guardian playfulness scores were all significantly associated with higher cat-guardian relationship scores. Exclusively indoor housing was significantly associated with both higher cat QOL and higher cat-guardian relationships scores compared to cats with outdoor access. Behavioural changes associated with distress in cats were reported when play was absent. Play may be an important factor in assessing and maintaining cat welfare. Further research into the mechanisms of how play impacts welfare and cat-guardian relationships is needed.

Evaluation of canine detection of COVID-19 infected individuals under controlled settings.

Reverse transcription polymerase chain reaction (RT-PCR) is currently the standard diagnostic method to detect symptomatic and asymptomatic individuals infected with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, RT-PCR results are not immediate and may falsely be negative before an infected individual sheds viral particles in the upper airways where swabs are collected. Infected individuals emit volatile organic compounds in their breath and sweat that are detectable by trained dogs. Here, we evaluate the diagnostic accuracy of dog detection against SARS-CoV-2 infection. Fifteen dogs previously trained at two centres in Australia were presented to axillary sweat specimens collected from known SARS-CoV-2 human cases (n = 100) and non-cases (n = 414). The true infection status of the cases and non-cases were confirmed based on RT-PCR results as well as clinical presentation. Across dogs, the overall diagnostic sensitivity (DSe) was 95.3% (95%CI: 93.1-97.6%) and diagnostic specificity (DSp) was 97.1% (95%CI: 90.7-100.0%). The DSp decreased significantly when non-case specimens were collected over 1 min rather than 20 min (p value = .004). The location of evaluation did not impact the detection performances. The accuracy of detection varied across dogs and experienced dogs revealed a marginally better DSp (p value = .016). The potential and limitations of this alternative detection tool are discussed.

Characteristics and outcomes of dog attacks to dogs and cats in Melbourne, Australia: A retrospective study of 459 cases (2018).

Dog-dog and dog-cat attacks can result in severe medical, financial, and emotional injury to pets and owners. The characteristics of dog-dog and dog-cat attack victims, the circumstances surrounding these attacks and the financial burden from veterinary visits is not reported in Australia. Medical records from 459 animals that were presented to the emergency service of four specialty hospitals in Melbourne, Australia in 2018 following a dog attack were assessed via univariate and multivariate methodologies with a retrospective case-control study design. Animals who had been attacked by a dog comprised 2.4% of the overall caseload at these four hospitals. Risk factors identified in dog-dog attack victims for presenting to a veterinary emergency hospital after being attacked were being cross-bred (OR = 1.4, p = 0.014, 95% CI = 1.07-1.84) and neutered (OR = 1.4, p = 0.035, 95% CI = 1.03-2.00). Being aged > 2-7years was protective (OR = 0.70, p = 0.010, CI = 0.48-0.88). Dogs from houses with a lower Socio-economic Indices for Areas score (SIEFA) were more likely to be attacked at home by a known attacker, compared to those from houses with a higher SIEFA score who were more likely to be attacked in public by a dog unknown to them (p = <0.001). Cats who presented following a dog attack had a 46.3% survival to discharge, compared to 91.8% in dogs (p < 0.001). Final cost of treatment for dogs and cats was similar (median AU $380 vs AU $360, respectively). Further research is needed to evaluate the population of dogs and cats attacked by dogs, to inform and direct public education campaigns aimed at reducing their incidence and overall burdens.

Why do veterinarians leave clinical practice? A qualitative study using thematic analysis.

BACKGROUND: Veterinarians have an important role in society and having an adequate veterinary workforce is important not only for their communities but also nationwide. Lately, there have been anecdotal reports regarding veterinary practices struggling to find clinicians as well as evidence of mental ill-health in veterinarians. Furthermore, the Australian Veterinary Association annual workforce survey shows an increased percentage of veterinarians intending to leave practice from 2017 to 2019. Although many factors for attrition have been described in other professions, reasons for veterinarians to leave practice are not well understood. METHODS: This study investigated why veterinary clinicians leave clinical practice by using Thematic Analysis to analyse 26 semi-structured interviews of former veterinary clinicians in relation to their work experiences and reasons for leaving. Interviews were done from February-April 2018 either face to face, via teleconferencing, or telephone. Participants were recruited from each Australian state except for New South Wales. RESULTS: The results showed that a combination of personal and work-related factors influenced the participants to leave clinical practice. In Personal Factors, participants described the internal and external circumstances that impacted on their personal lives such as personal relationships, experiencing negative thoughts and emotions, physical and mental health, core motivations and beliefs, alternative professional and personal interests. On the other hand, Work Experiences described situations, experiences, and statements directly related to the participant's veterinary clinical work such as workplace relationships, employment conditions including remuneration and working hours and clinical experiences such as negative clinical outcomes. Furthermore, interlinkages between these two themes were revealed in participants' responses. CONCLUSION: This study highlights factors that contribute to attrition from veterinary clinical practice. The narrative indicates that the interlinking of such factors influenced the decision-making process to leave clinical practice in this cohort of former veterinary clinicians. Further research is required to understand the full implications for veterinary clinical practice and inform intervention strategies for retention.

Resilience of veterinarians at different career stages: The role of self-efficacy, coping strategies and personal resources for resilience in veterinary practice.

BACKGROUND: The aim of this study was to determine the effect of demographic and psychological factors on resilience in new graduate-, mid- and late-career veterinarians working in Australia. METHOD: An online cross-sectional survey of 800 veterinarians collected demographic and descriptive data in two stages from late 2015 to 2017, such as gender, average hours worked per week, type and region of practice and intention to leave veterinary medicine. Psychological factors were measured utilising the Brief Resilience Scale, the Veterinary Resilience Scale-Personal Resources, the Brief COPE and General Self-Efficacy measures. RESULTS: Using a full-factorial univariate General Linear Model, no significant difference in general resilience was evident between the three career-stage groups (p > 0.05). However, higher self-efficacy, higher personal resources for resilience in veterinary practice, and lower problem-focused, higher emotion-focused and lower dysfunctional coping strategies were related to higher resilience. In the model for mid- and late-career veterinarians, a weak positive relationship existed between higher average hours worked per week and higher resilience, while intention to leave veterinary practice was also related to lower resilience in mid- and late-career veterinarians. CONCLUSION: This study supports the value of personal resources, rather than career stage, gender or region of work, as influential in developing veterinarian resilience.

Understanding the impacts of feline epilepsy on cats and their owners.

BACKGROUND: Epilepsy is the most common neurological condition reported in cats. Characterised by recurrent seizures, treatment involves the administration of anti-epileptic drugs up to multiple times a day. Epilepsy and its associated treatments may impact both cats and their owners. The present study aimed to assess factors associated with quality of life (QOL) in cats with epilepsy and the burden of care in their owners. METHODS: An online survey was developed using demographic information and the following validated measures: cat QOL, Zarit burden interview (ZBI) and the cat owner relationship scale (CORS). Regression analysis was conducted using SPSS 26. RESULTS: Responses were completed by 141 owners from 22 countries. QOL was significantly higher in cats with controlled seizures, no adverse effects from medication and epilepsy onset before 5 years of age. ZBI was significantly lower in owners who felt supported by their veterinarian, who were over 55 and had cats with controlled seizures. Higher CORS was significantly correlated with both higher cat QOL and lower owner ZBI. CONCLUSIONS: Adequate seizure control and close cat-owner relationships may play an important role in mitigating the impact of epilepsy on cats and their owners. Further research into understanding cat-owner relationships and successfully controlling epilepsy in cats is needed.

Review of the Online One Welfare Portal: Shared Curriculum Resources for Veterinary Undergraduate Learning and Teaching in Animal Welfare and Ethics.

This article introduces the online One Welfare learning and teaching portal (OWP) and describes its development, use, importance and relevance to animal welfare and ethics (AWE) stakeholders. As animal welfare issues increase in importance, veterinarians must be trained to lead the science that underpins AWE discourses. The OWP is a collection of resources designed to engage and challenge veterinary science students as they become advocates for animals. It was developed collaboratively by all eight veterinary schools in Australia and New Zealand, and funded by the Australian Government Office for Learning and Teaching. Surveys to investigate the attitudes of students and educators to AWE issues in six context-specific themes based on the Australian Animal Welfare Strategy (AAWS) (companion animals; animals used in research and teaching; livestock/production animals; animals used for sport, recreation or display; animals in the wild and aquatic animals) were administered through all participating schools. Students assigned more importance to Day One competence in knowledge of welfare concepts than did educators for the following groups: production animals, companion animals, animals in the wild, aquatic animals, animals used in research and teaching, and animals used for sport, recreation or display (all p < 0.01). Agreement between educators and students was closer regarding the importance of Day One competence for euthanasia for all six context-specific themes (p < 0.01 - 0.03). Students assigned more importance than educators to social, economic and cultural drivers of welfare outcomes in production animals (p < 0.01); slaughter and preslaughter inspections in production animals (p < 0.01); animal abuse and hoarding in companion animals (p < 0.01); shelter medicine in companion animals (p < 0.01); disaster preparedness in wildlife animals (p < 0.01); pain and distress caused by fishing in aquatic animals (p < 0.01); conscientious objection related to animals held for research and teaching (p < 0.01); behaviour, selection and training of animals used for sport, recreation and display (p = 0.046) and educating the public around sporting animal welfare (p < 0.01). Agreement between educators and students was closer for strategies to address painful husbandry procedures in production animals (p = 0.03); behaviour and training of companion animals (p = 0.03); veterinarians' duties to wild animals in wildlife (p = 0.02); the 3Rs in animals held for research and teaching (p = 0.03) and ownership responsibility in sporting animals (p = 0.01). This report discusses the reasons for differences among students and educators as they approach these issues. The portal is expected to gather more content as veterinary schools in other countries use its resources and users submit scenarios and discussion topics that reflect local needs.

Mental Health Disease or Preventable Problem? Australian Dog Trainers' Opinions about Canine Separation Anxiety Differ with Training Style.

Separation anxiety is common. Many dog owners do not seek help from a veterinarian but might consult a trainer. The objective of this study was to investigate Australian trainers' opinions about separation anxiety. An online survey was distributed via training organisations, resulting in 63 completed surveys. Descriptive statistics and Fisher's exact tests were applied. Respondents were grouped into reward-based (n = 41) and balanced (n = 22) trainers. Most trainers (82.5%) used multiple methods to identify separation anxiety but only 7.9% referred to a veterinarian for diagnosis. Reward-based trainers ranked assistance from a veterinarian and owner's willingness to try medication as more important than balanced trainers (p < 0.05). More balanced trainers reported that medication was rarely necessary in the cases they saw: 50% balanced compared with 4.9% reward-based trainers, with 95% CIs of [28.2, 71.8] and [0.6, 16.5], respectively. Almost all (95.5%) balanced trainers believed separation anxiety was preventable compared with 52.6% of reward-based trainers (p < 0.05). We conclude that opinions about separation anxiety varied between reward-based and balanced trainers. Trainers are not taught, expected, or legally allowed to diagnose anxiety disorders. This study showed that balanced trainers were less likely to recommend involvement of veterinarians who can make a diagnosis and rule out other causes of observed behaviours.

Regulatory Compliance in Online Dog Advertisements in Australia.

In Australia, each state and territory authority implements and enforces regulations regarding dog management-including the breeding and sale of dogs online-which is increasingly becoming the most popular method of obtaining pets. The aims for this study included: 1. Benchmarking regulatory compliance in online dog advertisements in Australia, and, 2. Understanding factors associated with regulatory compliance in online advertisements. We collected advertisements for dogs and puppies from Gumtree-one of Australia's most popular online trading platforms - on two separate days, two weeks apart (25 March and 8 April 2019). A total of 1735 unique advertisements were included in the dataset. Chi-squared tests and multivariable logistic regression models were used to identify risk factors for microchipping, desexing and breeder identification number, and compliance levels. State laws requiring animals to be microchipped prior to sale and the inclusion of chip numbers in advertisements were found to be the biggest factor in increasing likelihood of microchipped animals in Gumtree advertisements, while desexing was more common in microchipped and older animals. The online ad was more likely to include a breeder ID if the dog was young, vaccinated, and advertised by a breeder rather than an owner. The findings from this study will assist regulators to make evidence-based decisions on managing online advertisements for companion animals. In the future, the benchmarking this study has presented will allow future analysis of the effectiveness of regulation changes.

Impact of Non-Confinement Accommodation on Farrowing Performance: A Systematic Review and Meta-Analysis of Farrowing Crates Versus Pens.

There are conflicting reports regarding the effect of farrowing house accommodation on piglet performance. The aim of this investigation was to use a systematic review and meta-analyses to summarise the results of publications that focused on direct comparisons between full confinement conventional crates and various designs of loose-housed farrowing pens from loading until weaning. Literature searches in Scopus, BIOSIS Previews, Cab Abstracts, and Web of Science identified 6695 articles. Twenty-two publications were retained for the systematic review and individual meta-analyses after screening for inclusion criteria. The random effects meta-analyses were performed on crate versus pen for number of piglets born alive, number of stillborn piglets, pre-weaning mortality, and number of piglets weaned. Additionally, the modifiers of confinement length (no confinement from loading until weaning or partial confinement for shorter periods of time in the early stages post parturition), enrichment (no enrichment or enrichment provided), and pen size (small, medium, or large) were examined. There was a 14% increase in the relative risk of piglet mortality in farrowing pens when they were compared with crates (p = 0.0015). The number of stillborns per litter was not different between the pen and crate. However, when providing enrichment in the pens, there was an increase in stillborns within farrowing crates versus pens (p = 0.009). There was no overall effect on piglets that were born alive or number weaned. As there is no difference between piglets born alive and mortality is significantly higher in farrowing pens, a reduction in the number of piglets weaned was expected but not observed, which was possibly due to the lack of weaning details provided in the publications. This was the first systematic review and meta-analysis conducted on the performance of farrowing accommodation and identified that farrowing pens do compromise post-natal piglet survival. Future efforts should focus on improving sow comfort in the farrowing crate to maximize both piglet and sow welfare.

Restraint of dogs in vehicles in the US, UK and Australia.

Although dogs routinely travel in motor vehicles, there is a lack of evidence on if, how, and why people choose to restrain their dogs when travelling. A lack of restraint is likely to be associated with an increased risk of serious injury or death in the case of an accident, and in some cases may even precipitate an accident. The aim of the present study was to determine the frequency in which dog restraints are used in the US, UK and Australia in a convenience sample, and the factors associated with whether or not a dog is restrained. Online surveys using SurveyMonkey® were distributed in the US, UK and Australia during 2017-2018. The survey consisted of questions related to owning a dog, owner and dog demographics, use of restraint when driving with the dog, reasons for restraining/not restraining the dog, and attitudes to restraint of dogs in vehicles. A logistic regression was used to determine factors associated with the use of restraint. There were 706, 692 and 637 completed surveys from the US, UK and Australia, respectively. A little over half of respondents restrained their dog in the US (55%) compared to 67% in Australia and 72% in the UK. The most common method of restraint in the US and UK was a cage/crate in the cargo area in the back of the vehicle; in Australia it was a harness and tether attached to a seat buckle. In the generalised linear model, country, dog size, owner age, dog age and vehicle type were all significant factors associated with the use of restraint for dogs in cars. Younger dog owners from the US who drove a pickup truck or utility van, had a large dog, and drove with their dogs less frequently were least likely to restrain their dogs. This research highlights the need for improved education and information regarding the use of restraints for dogs traveling in vehicles, although the limitations in the convenience sample used mean further research is needed, including use of a more representative sample.

Moral distress in veterinarians.

Moral distress is a psychological state of anguish that has been widely studied in healthcare professionals. Experiencing moral distress can lead to problems including avoidance of patients and increased staff turnover. Moral distress in veterinarians has not yet been explored to the extent seen in the human medical field, and there is limited data regarding moral distress in veterinarians. However, it is expected to be prevalent in these professionals. So far, it has been reported that veterinarians commonly experience moral conflict, ethical challenges and ethical dilemmas during their career. These conflicts in association with other modifying factors such as personality traits can lead to the experience of moral distress. In a profession with known levels of occupational stress and reported mental health problems, exploring the area of moral distress and its effects on the professional wellbeing of veterinarians is important. Further studies such as developing a moral distress scale to measure this issue are needed in order to evaluate the incidence of this problem in veterinary professionals. Furthermore, assessing a possible relationship between moral distress, mental illness and attrition in veterinarians would be useful in developing intervention strategies to minimise the experience of moral distress and its associated negative consequences in veterinarians.

Investigating risk factors that predict a dog's fear during veterinary consultations.

Attending the veterinary clinic is an integral part of the physical welfare of every companion dog. However, some dogs experience their veterinary visits negatively, which poses a risk of injury to the veterinary staff, their guardian (owner) and themselves. It may also influence the regularity of non-urgent veterinary appointments. To date there have been conflicting reports relating to the proportion of dogs that show fear during their veterinary visits. In this study, we explored the risk factors associated with fear during veterinary examination and in novel situations (including first time at the veterinary clinic) from 26,555 responses in the Canine Behavioral Assessment and Research Questionnaire database. According to their guardians, 41% of companion dogs displayed mild to moderate fearful behaviour when examined by a veterinarian, and 14% exhibited severe or extreme fear. A similar trend was observed with dogs responding fearfully when in unfamiliar situations, including the dog's first time at the veterinary clinic. Chi-squared tests showed every bivariate relationship between fear and the environmental and demographic factors measured was significant (p < 0.05). The most important predictors of fear in a veterinary examination were, in order: the dog's breed group (27.1%), their history of roles or activities (16.7%), where they were sourced (15.2%), their weight (12%), the age of other dogs in the household (9.5%) and dog owner experience (6.3%). However, combined these risk factors only explain a total of 7% of variance of fear observed during veterinary examination. This suggests that fear exhibited during veterinary visits is common in dogs, but that the environment or human-animal interactions are likely to contribute more to prevalence and severity of this problem than the demographic factors measured here. We conclude by highlighting opportunities for future research aimed at facilitating less stressful veterinary visits for dogs and their guardians.