Search

Purpose: A laparoscopic approach for emergency appendectomy is increasingly used, in pediatric patients as well. The objective of this study is to audit the current state of diagnostic work-up, surgical techniques and its outcome in children with acute appendicitis.Methods: A prospective consecutive observational cohort study was carried out in a 2-month study period. All patients under 18 years that were operated for suspected acute appendicitis were included. Primary outcome was the infectious complication rate after open and laparoscopic approach; secondary outcomes were preoperative use of imaging and post-operative predictive value of imaging, normal appendix rate and children with a postoperative ileus.Results: A total of 541 children were operated for suspected acute appendicitis in 62 Dutch hospitals. Preoperative imaging was used in 98.9% of children. The normal appendix rate was 3.1%. In 523 children an appendectomy was performed. Laparoscopy was used in 61% of the patients and conversion rate was 1.7%. Complicated appendicitis was diagnosed in 29.4% of children. Overall 30-day complication rate was 11.9% and similar after open and laparoscopic. No difference was found in superficial surgical site infections, nor in intra-abdominal abscesses between the open and laparoscopic approach. Complicated appendicitis is an independent risk factor for infectious complications.Conclusion: The laparoscopic approach is most frequently used, except for young children. Superficial surgical site infections are more frequent after open surgery only in patients with complicated appendicitis. The normal appendix rate is low, most likely because of routine preoperative imaging. [ABSTRACT FROM AUTHOR]

Purpose: Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence of intra-abdominal abscesses. The aim of this study was to evaluate the outcome of surgical approaches in both simple and complex appendicitis in paediatric patients. Methods: A 10-year retrospective cohort study was performed (2001-2010) in paediatric patients treated for suspected acute appendicitis. Patients were divided into either simple or complex appendicitis and into different age groups. Primary outcome parameters were complication rate (intra-abdominal abscess (IAA), superficial surgical site infection (SSI) and readmission) and hospital stay. Results: In total, 878 patients have been treated (median age 12, range 0-17 years). Two-thirds of the patients younger than 6 years had complex appendicitis, compared to one quarter in the group aged 13-18. In the complex appendicitis group, LA was associated with more IAA and early readmissions. In the simple appendicitis group, the complication rate was comparable between the two approaches. Significantly more IAAs were seen after LA in the youngest age group. Conclusion: This study demonstrates the unfavourable outcome of LA in the youngest age group and in patients with complex appendicitis. Therefore, we advise to treat these patients with an open approach. [ABSTRACT FROM AUTHOR]

Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. Methods: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow-up questionnaire which included a measure to determine which participants were 'improved' or 'not improved'. To study which predictive variables were associated with improvement, multiple regression models were built. Results: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow-up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6-month follow-up. Pain duration was the strongest (negative) predictor for 6-month improvement ( P = 0·009). Also the number of care providers ( P = 0·017) and the degree of hindrance on function ( P = 0·045) helped to predict improvement. Conclusions: The duration of the TMD-pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6-month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain. [ABSTRACT FROM AUTHOR]

Objectives To investigate if women compared with men dentists experience deferential treatment from their female nurses, what workplace strategies women use to manage chair-side assistance and to examine if these were country related.Method A convenience sample of 22 male and female dentists of different ages working in general dental practice in The Netherlands and Northern Ireland participated. The sample framework was determined by saturation of the concepts. All informants were interviewed in a clinical setting. The data was subjected to rigorous line by line coding in order to identify clusters of codes, themes and concepts.Results Three themes were identified. These were: experiencing deferential nursing assistance; adopting 'friendly-like' working strategies and adopting business-like, hierarchical working strategies. Gender differences were shown for each of the themes. Women rather than men made friends with their nurses and attempted to reduce status inequalities. This led to workplace strategy inconsistencies. This suggested that it was not the type of strategy adopted but the inconsistency with which it was implemented that caused difficulties between younger women dentists and their nurses.Conclusions Training dental students and young graduates how to interact appropriately in the clinical situation and to appreciate the nurses' work status will assist in improving working relationships. [ABSTRACT FROM AUTHOR]

Background Digital technologies are proliferating into dental practices. While their technical attributes have often been studied, it remains unclear why some dentists adopt and use these technologies more than others.Aim To explore the incentives for and barriers against accepting and using digital dental technologies.Method Eleven semi-structured qualitative interviews were conducted with experts in dentistry, dental technology and dental education in the Netherlands. Results Dentists' acceptance and use of digital technologies are to varying degrees driven by the perceived advantages over analogue methods, perceived influence on treatment quality, dentists' personal and professional orientation, and social influence from peers and external groups. These effects are complemented by personal and dental-practice characteristics. Conclusions The findings suggest that there are large differences in motivation to adopt and use digital technologies between early adopters, late adopters and non-adopters, which should be examined in greater detail. We recommend that educators, dentists, and representatives of the dental industry who deal with the diffusion of these technologies take account of dentists' widely different attitudes to digitalisation. [ABSTRACT FROM AUTHOR]

ObjectivesTo investigate if female compared with male dentists experience deferential treatment from their female nurses, what workplace strategies women use to manage chair-side assistance and to examine if these were country related.MethodA convenience sample of 22 male and female dentists of different ages working in general dental practice in The Netherlands and Northern Ireland participated. The sample framework was determined by saturation of the concepts. All informants were interviewed in a clinical setting. The data was subjected to rigorous line by line coding in order to identify clusters of codes, themes and concepts.ResultsThree themes were identified. These were: experiencing deferential nursing assistance; adopting 'friendly-like' working strategies and adopting business-like, hierarchical working strategies. Gender differences were shown for each of the themes. Women rather than men made friends with their nurses and attempted to reduce status inequalities. This led to workplace strategy inconsistencies. This suggested that it was not the type of strategy adopted but the inconsistency with which it was implemented that caused difficulties between younger women dentists and their nurses.ConclusionsTraining dental students and young graduates how to interact appropriately in the clinical situation and to appreciate the nurses' work status will assist in improving working relationships. [ABSTRACT FROM AUTHOR]

Objectives: To describe incidence, clinical course, diagnostic and therapeutic management and long-term follow-up of paediatric intestinal pseudo-obstruction (PIPO) in the Netherlands between 2000 and 2020., Methods: Multicenter, national, retrospective, observational study including patients aged <18 years diagnosed with PIPO and treated between 2000 and 2020 in Dutch academic medical centres. Outcomes included demographics, incidence, symptoms, diagnostic- and treatment methods used during follow-up, number of hospital admissions and mortality., Results: Between 2000 and 2020, 43 children (median age 120 months, range 13-301, 54% female) were diagnosed with PIPO in the Netherlands. Mean incidence was 0.008/100,000/years (range 0/100 000-0.029/100 000). Twenty-six patients developed PIPO in the neonatal period. Initial symptoms were vomiting (n = 21/35, 60%) and abdominal distension (n = 14/35, 40%). Diagnostic strategies included imaging, manometry, histopathology, metabolic- and genetic screening, endoscopy and exploratory surgery. Treatment was divided in nutritional support, pharmacotherapy, colonic irrigation and surgical interventions, of which nutrition and surgery were the cornerstones for care. During the observed study period, the median number of hospital admissions was 22.5 (range 1-176) with a median of 157.5 days (range 3-840) during 20-year follow-up. Two patients (6%) died: one from sepsis and one due to a severe underlying neurological disease. Heterogeneity in diagnostic- en treatment methods existed between patients., Conclusions: PIPO is a rare, long-lasting complex disease requiring a high number of diagnostic and therapeutic interventions and hospital admissions. However, mortality rate is relatively low. Based on our results, we recommend centralization and standardization of care for this complex rare disease., (© 2024 The Author(s). Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Coinciding with an increasing tendency of professionals to cross national borders, there is also an increasing need to harmonise curricula. In dentistry in Europe, this tendency is undiminished. By defining international curriculum requirements for dentists, international harmonisation can be strengthened. In the Netherlands, too, harmonisation with European standards has taken place in establishing final achievement levels for dentistry curricula, as defined in a national framework. In a working environment where oral health professionals are confronted with rapid change, for example, in the division of responsibilities, future caregivers should have an optimal educational preparation for their competences, skills and expertise.

Purpose: The Prospective Research in Stress-Related Military Operations (PRISMO) study was initiated to gain a better understanding of the long-term impact of military deployment on mental health, and to map the different biological and psychological factors that contribute to the development of stress-related mental health symptoms., Participants: The PRISMO cohort consists of a convenience sample of Dutch military personnel deployed to Afghanistan between 2005 and 2008. Baseline data collection resulted in the recruitment of 1032 military men and women. Combat troops as well as non-combat support troops were recruited to increase the representativeness of the sample to the population as a whole., Findings to Date: The prevalence of various mental health symptoms increases after deployment in PRISMO cohort members, but symptom progression over time appears to be specific for various mental health symptoms. For post-traumatic stress disorder, we found a short-term symptom increase within 6 months after deployment (8.2%), and a long-term symptom increase at 5 years after deployment (12.9%). Several biological vulnerability factors associated with the development of stress-related conditions after deployment were identified, including predeployment glucocorticoid receptor sensitivity and predeployment testosterone level. Thus far, 34 publications have resulted from the cohort., Future Plans: Various analyses are planned that will include the prevalence of mental health symptoms at 10 years postdeployment, as well as trajectory analyses that capture the longitudinal development of symptoms. Furthermore, we will use a machine learning approach to develop predictive and network models for several mental health symptoms, incorporating biological, psychological and social factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In response to the initiatives of the Kennisinstituut Mondzorg (Institute for Knowledge Translation in Oral Care), the importance of effective education in the area of guidelines is increasing. Future dentists will, after all, be confronted with new guidelines and need to be able to integrate them in their daily practice. Various guidelines and protocols have been established within the 3 dental schools. For students and instructors, however, the motivation for these guidelines and protocols is not always sufficiently clear. In addition, the terms guideline, clinical practice guideline and protocol are used interchangeably, resulting in terminological confusion. Embedding within and coordination with theoretical education is also still limited in all programmes and it is proposed that the 3 dental schools collaborate on this issue. Finally, it is advised to replace the term 'evidence-based' with 'evidence-informed' because this indicates more clearly that other factors (patients opinion, available financial means, etc.) play a role in the final choice of treatment in a specific situation.

Background: Multi-item questionnaires are important instruments for monitoring health in epidemiological longitudinal studies. Mostly sum-scores are used as a summary measure for these multi-item questionnaires. The objective of this study was to show the negative impact of using sum-score based longitudinal data analysis instead of Item Response Theory (IRT)-based plausible values., Methods: In a simulation study (varying the number of items, sample size, and distribution of the outcomes) the parameter estimates resulting from both modeling techniques were compared to the true values. Next, the models were applied to an example dataset from the Amsterdam Growth and Health Longitudinal Study (AGHLS)., Results: The results show that using sum-scores leads to overestimation of the within person (repeated measurement) variance and underestimation of the between person variance., Conclusions: We recommend using IRT-based plausible value techniques for analyzing repeatedly measured multi-item questionnaire data.

The professional behaviour of future dentists is an important topic in dental curricula. Aspects of professional behaviour are, among other things: being respectful to patients, putting the interest of the patients first, reliability, integrity, and knowing one's professional limitations and acting according to them when treating patients. Throughout the curriculum students receive feedback on their functioning with regard to professional behaviour and are also examined on those points. At the programme at the Academic Centre for Dentistry Amsterdam, experience has been gained in recent years in addressing and evaluating (un)professional behaviour among students.

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels., (© 2012 Eur J Oral Sci.)

The aim of this study was to measure Dutch oral surgeons' levels of burn-out risk and the contributing role of demanding working conditions. In addition, the extent of work engagement was considered, and which stimulating working conditions contributed to it. All 179 Dutch oral surgeons registered in the Dutch Dental Association's files received a questionnaire by means of which burn-out, work engagement and both demanding and stimulating aspects from the work environment could be measured. Based upon a 70% response, it can be concluded that Dutch oral surgeons have a relatively low risk of burn-out and a high degree of engagement. Demanding working conditions which explain the differences in the risk of burn-out are: 'Pressure of work and clinic organization', and 'Lack of variation and perspective in work'. Differences in enthusiasm were best explained by 'Variety in work', and 'Positive effect upon patients'. It is remarkable that the mean for all demanding aspects of work is relatively low and the mean for all stimulating aspects is relatively high.

Since the introduction of the bachelor-master structure five years ago at the Amsterdam Dental School, the evaluation and assessment of professional behaviour has been an examination subject in the bachelor programme. Professional behaviour is understood to be the student's observable behaviour in the educational setting, as distinguished from someone's inner beliefs or convictions. The core of this element in the curriculum is the feedback which the student regularly receives from several teachers concerning their behavior, given whatis expected from a medical professional. The programme's requirement is that a third year student demonstrably has sufficient satisfactory evaluations to earn the necessary study credits.

Unlabelled: Psychological stress in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools., Objective: To compare the levels of a series of health-related indicators from a cohort of fifth year dental students from five European schools with their first year scores, and to investigate the relationship between these follow-up measures., Methods: Burnout was measured using the Maslach Burnout Inventory (MBI), consisting of three scales: Emotional Exhaustion (EE, alpha = 0.90), Depersonalisation (alpha = 0.80) and Personal Accomplishment (alpha = 0.72). Physical health was measured by the Physical Symptoms Questionnaire (alpha = 0.82), psychological distress was measured using the General Health Questionnaire (GHQ, alpha = 0.89) and student stress was captured using seven subscales of the Dental Environment Stress questionnaire (DES, alpha = 0.92). A total of 132 fifth year students responded from five dental schools (Manchester, Belfast, Cork, Helsinki and Amsterdam), a 51% response., Results: Fifth year students showed relatively high mean MBI scores when compared with first year results, especially on EE; 39% could be labelled 'high scorers'; 44% of the students met the criteria for 'cases' on the GHQ. Highest mean scores on the DES were obtained on the subscales: Study Obligations, Patient-Related Aspects and Study Pressure respectively. Between schools interesting differences were detected on all variables. As hypothesised, a clear direct effect of stress on both burnout and physical symptoms was shown. An indirect effect of stress on mental health via burnout was shown., Conclusions: Dental students showed a negative development through the years from first to fifth year with regard to EE and psychological distress. Both burnout constructs related to physical and mental health. It is recommended that dental faculty focus on the importance of prevention and intervention of stress amongst undergraduates.

Objectives: To extend our knowledge about the applicability of the Maslach Burnout Inventory (MBI) among dentists and to investigate trends in burnout risk among dental professionals., Methods: The structure of the MBI is examined among two independent, representative samples of dentists (n = 493 and 497, respectively). Moreover, results are compared to those of other independently-practicing health professionals (i.e., general practitioners and physiotherapists). In addition, the percentage of dentists that are at risk for burnout are compared in samples from 1997, 2000, and 2001., Results: Correlations between the Emotional Exhaustion and Depersonalization subscales among dentists were higher than those found elsewhere. Additionally, a considerable increase in burnout risk was found since 1997., Conclusions: It was confirmed that the MBI can be considered a suitable instrument for use among dentists. It is argued that certain specific aspects of entrepreneur-like occupations are reflected in deviating responses to the MBI. Given the clear increase in burnout risk found, this topic should remain under investigation among dentists.

Objectives: To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners., Methods: In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response)., Results: Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%)., Conclusions: Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

A recent development within burnout research is the shift to its conceptual opposite: work engagement. This study aimed to unravel the concepts of burnout and work engagement, and to determine their levels among dentists. A representative sample of 497 Dutch general dental practitioners was included (survey response rate of 59%), consisting of 372 men and 121 women (the gender of 4 dentists remained unknown). The hypothesized three-factor structure of work engagement (vigor, dedication, and absorption), as measured by the Utrecht Work Engagement Scale (UWES), was substantiated among dentists. It was also found that work engagement was related negatively to burnout, as measured by the Maslach Burnout Inventory (MBI). However, a model consisting of a reduced ('core') burnout factor and an 'enhanced' engagement factor (composed of the three original factors plus the burnout factor, personal accomplishment) showed the best fit. Overall burnout levels among dentists are low, and the levels of engagement indicate that dentists have a positive working attitude.

Objectives: To investigate if dental nurses perceive gender differences in the communication and interaction style used by their dentist in general practice., Methods: Data were collected from 64 Northern Irish dental nurses (70% response), and from 549 Dutch nurses (41% response). Respondents completed the Communication and Working Styles Questionnaire (CWSQ), a self-report questionnaire with 20 items on staff communication and working styles. Using principal component analysis, six distinguishable factors could be extracted: [1] gender-related (four items, Cronbach's alpha = 0.78), [2] friendly relation (four items, alpha = 0.66), [3] teamwork (four items, alpha = 0.44), [4] playfulness (two items, alpha = 0.69), [5] personal attention (three items, alpha = 0.60), and [6] business-like (two items, alpha = 0.32). Factors [3] and [6] were additionally analysed at item level given their low internal consistencies., Results: MANOVA indicated a main effect for dentist's gender [F(6,541) = 4.649, p < 0.001], and for country [F(6,541) = 37.601, p < 0.001] on the communication style scales. No interaction effect of gender with country was found. Nurses working with a male dentist had higher scores for the 'gender-related' communications styles, whereas those working with a female dentist had higher scores for 'friendly-relation' and 'personal attention' communication styles. Dutch nurses had higher scores on 'playfulness', whereas Northern Irish nurses had higher scores on 'friendly relation' and 'personal attention' communication styles. Some additional differences were found at item level. The age of the dental nurse explained some differences in communication and working styles [F(6,541) = 2.341, p = 0.031); younger dental nurses scored significantly higher for 'gender- related' communication and working style., Conclusion: Gender of the dentist does influence dental nurses' perceptions of the communication styles used in the primary dental care setting. Dental nurses working with female dentists report a style predominantly characterized by 'friendly-relation' and 'personal attention', whereas those working with a male dentist report 'gender-related' communication and working styles. Given the steadily growing percentage of females entering the dental profession, it is recommended to raise both dentists' and nurses' awareness on gender influences in professional communication by introducing these topics in their respective education.

Aim: To develop an instrument measuring job resources among dentists, and to assess the relative importance of these resources and relate them to job satisfaction., Methods: 848 Dutch general dental practitioners (GDPs) received a questionnaire to monitor work experiences, including the Dentists' Experienced Job Resources Scale (DEJRS, 46 items, score range: 1 (not satisfying) to 5 (very satisfying), and the Dentist Job Satisfaction Scale (DJSS, 5 items, Cronbach's alpha = 0.85)., Results: A total of 497 (58.6%) dentists responded. Factor analysis (PCA) on the DEJRS resulted in 8 factors (Cronbach's alpha: 0.75 > alpha < 0.89), representing distinguishable categories of job resources. In rank order: Immediate Results / Aesthetics (M = 4.04, sd = 0.5); (Long-term) Patient Results (M = 4.03, sd = 0.6); Patient Care (M = 3.90, sd = 0.6); Craftmanship (M = 3.77, sd = 0.7); Idealism / Pride (M = 3.65, sd= 0.6); Entrepreneurship (M = 3.55, sd = 0.9); Material Benefits (M = 3.05, sd = 0.7); and Professional Contacts (M = 3.03, sd = 0.7). MANOVA indicated gender differences on: (Long-term) Patient Results (F(1,548) = 10.428, p = .001), and Patient Care (F(1,548) = 11.036, p < .001). Subscale correlations with the total DEJRS are: 0.57 > r < 0.88. All subscales show a positive correlation with the DJSS., Discussion: The DEJRS is a valuable and psychometrically sound instrument to monitor job resources as experienced by GDPs. Dentists report immediate results and aesthetics, and long-term results of working with patients to be the most rewarding aspects. All job resources showed a positive correlation with job satisfaction. The discussion includes conjecture that stimulating a greater awareness of job resources serves a major role in burnout prevention.

Objectives: The Stress Thermometer is an easily accessible Internet-based instrument for feedback on work stress and burnout. The aim of this paper is to describe the development of this instrument and to determine its applicability within the dental practice., Methods: The Stress Thermometer was made accessible to all members of the Dutch Dental Association, of which 77% of all Dutch dentists are members. Frequency of use was determined, and descriptive data was collected., Results: During an evaluation period of 5 months at least 12% of all possible respondents made use of the Stress Thermometer. Descriptive characteristics of the response group, as well as levels of burnout and work stress, corresponded with those found in the Dutch dentist population. However, some deviations were also present., Conclusions: Results indicate the applicability of the Stress Thermometer to a representative variety of dentists. Although the deviations found should not be ignored in future use, the Stress Thermometer was successful in reaching a population that is difficult to reach. It effectively calls attention to sensitive personal issues concerning work-related stress and burnout.

The aim of this study was to measure if dentists with unfulfilled career expectations have higher burnout scores than dentists who succeeded in realising their expectations. Furthermore, the relation between type of dentist and burnout was investigated. It appeared that dentists who experienced reality being worse than expected, showed higher burnout levels, as did dentists putting more interest in life outside practice. It is recommended that attention for realistic career expectations is a regularly recurring topic in dental education. Also, introspection upon the type of dentist one prefers to be is something a professional should not neglect.

Work stress and burnout are considered to be serious professional risks in dentistry. This study investigated the relation between a dentist's coping style and burnout level. It was hypothesized that dentists characterized by an active coping style would show relatively low burnout levels, whereas dentists characterized by a passive coping style would show relatively high burnout levels. From a survey among 709 active general dental practitioners, who filled out the Maslach Burnout Inventory and the Utrecht Coping List, this hypothesis was supported. It was concluded that coping style could explain differences in burnout levels to a substantial degree. In the discussion the need for feedback on one's coping style, and the importance of an individual dentist's active attitude towards career planning, among other things, are emphasized.

The effects on burnout of a career counseling program were measured among general dental practitioners. Out of a group of 171 dentists, identified with unfavorable scores on the Maslach Burnout Inventory - Dutch version (MBI-NL), nineteen chose to participate in the program. It consisted of individual counseling and group sessions, using cognitive and behavioral intervention techniques, over a 6-month period. One month after the last session, both program participants (N=17) and invited, but not participating, dentists (N=66) again filled in the MBI-NL. Comparison of participants' pre- and post-test scores showed significant statistical improvement on the MBI-NL scales emotional exhaustion (EE), and personal accomplishment (PA). Among the control group, a distinction was made between dentists who had self-initiated preventive measures (N=35) and those who had not (N=31). Self-prevention also appeared to have an effect on EE and PA. Among dentists who reported not to have undertaken preventive action, no change in burnout levels was found. With reservations, it can be concluded that the prevention program does have a positive effect on burnout scores among dentists, while different forms of self-initiated prevention activities also appeared to be effective.

This study aimed at monitoring stressful work factors as indicated by Dutch general dental practitioners. Special attention was given to gender differences. Apart from mental pressure also physical pressure was studied. It appeared that among all dentists patient related aspects were considered stressful, als well as external interference by government, insurance company, etc. Male dentists also felt pressure from a lack of career perspective and dental office management, whereas female dentists felt pressure from unexpected or uncertain professional situations. Dentists appeared to have a good physical health, when compared with Dutch reference scores, although some job specific physical complaints could be detected. In the discussion the importance of early career planning is emphasized.

In this study, it was hypothesised that dentists with a high burnout risk would experience more health complaints and show more unhealthy behaviour when compared with dentists with a low burnout risk. With a response rate of 75%, a representative group of 709 actively practising dentists responded to a questionnaire containing the Dutch version of the Maslach Burnout Inventory (MBI-NL), a health complaints measure (VOEG), and items on health behaviour. Results showed that dentists with a high burnout risk reported health complaints to a greater extent than dentists with a low burnout risk. They also reported more unhealthy behaviour in some aspects (physical exercise/sporting, increase in alcohol consumption, unhealthy diet), but not in others. It also appeared that one out of ten dentists reported having poor general health, and that three out of ten reported to have poor physical condition. In general, dentists' self-reports appeared favourable in comparison with the Dutch population. It is concluded from this study that among dentists burnout and poor health are strongly related. It is discussed that in order to deal preventively with burnout in dentistry, attention to physical health, including ergonomics, is essential.

Individual differences among dentists determine to a large degree what is experienced as work stress, but assessment of specific areas is necessary to be able to act preventively. The aim of this study was to develop an instrument to be used to monitor the experience of work stress in detail, to measure its levels, and to relate those levels to job (dis-) satisfaction. A questionnaire was developed, the Dentists' Experienced Work Stress Scale (DEWSS), covering widespread aspects of dental work, which was completed by 709 dentists, forming a highly representative sample of Dutch general dental practitioners. Factorial, correlational, and reliability analyses were conducted, after which seven areas of stress emerged: Work Pressure, Financial Aspects, Patient Contacts, Work Contents, Career Aspects, Team Aspects, and Professional and Private Life. Of these, Patient Contacts and Work Contents showed highest mean scores, as did the specific items: 'defaulters', 'governmental instructions', and 'unreasonable or demanding patients'. A strong inverse relationship was found between work stress, in particular lack of career perspective, and job satisfaction. The questionnaire is a valuable instrument to monitor pressure at work as felt by Dutch general dental practitioners. Patient contacts, work pressure, and career perspective clearly need preventive attention in the Dutch situation.

Unlabelled: Professional burnout, a long-term consequence of occupational stress, is considered to be a factor that explains a substantial proportion of incapacity for work. Burnout is defined as emotional exhaustion, depersonalization, and diminished personal accomplishment., Aims: To investigate levels of burnout among Dutch practising dentists, to compare dentists' scores with norm scores, and to determine the percentage of dentists "at risk"., Methods: The instrument used was the Dutch version of the Maslach Burnout Inventory (MBI-NL), a 20-item modified version of the original MBI. A highly representative group of Dutch dentists participated (n = 709, 75% response rate)., Results: Mean levels (and standard deviations) of burnout were: emotional exhaustion 13.7 (8.6); depersonalization 5.9 (3.9); personal accomplishment 30.8 (5.9). Dentists had more favourable means compared with standard scores, although in the 95th percentile dentists showed more emotional exhaustion than standards indicate. While no overall sex differences were found, male middle-aged dentists tended to show more burnout. Of the working Dutch dentists, 21% had a certain risk, 13% had high overall levels of burnout, and 2.5% were highly burned out., Conclusion: It is concluded that Dutch dentists have relatively favourable mean levels of burnout, but those who are exhausted are extremely exhausted. The male dentist in his forties appears to be most vulnerable to burnout.

Work stress among dentists has been described several times, indicating a diversity of causes of stress. Professional burnout among dentists has been the subject of empirical study only occasionally. The aim of the present study was to investigate which occupational factors are related to levels of burnout among Dutch dentists. A distinction was made between actual work place characteristics and experienced pressure from specific aspects of dental work. With a response rate of 75%, a representative group of 709 Dutch general dental practitioners responded to a questionnaire containing a Dutch version of the Maslach Burnout Inventory (MBI-NL), the Dentists' Experienced Work Stress Scale (DEWSS), and a collection of items on work place conditions. No actual work place condition could be demonstrated to be correlated with high burnout levels. Lack of career perspective appeared to be the stress factor most strongly related to burnout. Mean burnout levels of all dentists were found to be favourable in comparison with Dutch norm scores: dentists showed less Emotional Exhaustion, less Depersonalization, and more Personal Accomplishment. It is concluded that the relation between lack of career perspective and burnout should stimulate serious attention for career planning among dentists.

In this article, some reasons for teaching communication skills in dental schools are discussed. An overview of 3 courses at the Amsterdam dental school is presented, along with the results of a student evaluation. Students evaluated these courses as useful and relevant for dental practice. It is concluded that this is especially so when the students recognize direct applicability of the courses to dental practice.