Is Dental Anxiety Associated with Oral Health-Related Quality of Life? Assessment of Statistical Significance and Clinical Meaningfulness in a Sample of Russian Medical and Dental Students.

Information about oral health-related quality of life (OHRQoL) and dental anxiety (DA) in Russian young adults is scarce. We investigated how DA is associated with OHRQoL in a group of medical and dental students in North-West Russia. The study had a cross-sectional design and included 807 students aged 18-25 years who attended the Northern State Medical University in Arkhangelsk. OHRQoL and DA were measured by the Oral Health Impact Profile (OHIP-14) and Corah's Dental Anxiety Scale (DAS), respectively. A questionnaire collected information on socio-demographics and self-reported oral health (OH) characteristics. A dental examination was executed to assess dental caries and oral hygiene. We observed differences in the OHIP-14 scores between dentally anxious and non-anxious students: unadjusted incidence rate ratio [IRR] = 1.65, 95% confidence interval [CI]: 1.29-2.12; after adjustment for socio-demographics and clinically assessed OH: IRR = 1.58, 95% CI: 1.23-2.02; after adjustment for socio-demographics, clinically assessed OH, and self-reported OH characteristics: IRR = 1.27, 95% CI: 0.99-1.63. The differences between estimated marginal means for the DAS categories in the models were 2.92, 2.51, and 1.24, respectively. Minimal clinically important differences of OHIP-14 fell between 1.68 and 2.51. We found a negative statistical association between DA and OHRQoL in our study sample, but after adjustment for potential confounders, the association lost its clinical importance.

Dental professionals' views on motivational interviewing for the prevention of dental caries with adolescents in central Norway.

BACKGROUND: Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients. METHODS: As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level. RESULTS: A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists. CONCLUSIONS: A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.

Procedure time and filling quality for bulk-fill base and conventional incremental composite techniques-A randomised controlled in vitro trial.

OBJECTIVES: The aims of this randomised controlled laboratory trial were to determine the procedure time and immediate quality (surface porosity and marginal gaps) of fillings placed using the bulk-fill base technique and the conventional incremental technique in simulated clinical settings. METHODS: Forty-two dentists and dental students were randomly allocated to use either the bulk-fill base technique or the conventional incremental technique to fill an identical class II disto-occlusal cavity in a maxillary left first molar typodont tooth. We recorded the time the participants used to fill the cavity and evaluated the surface porosity and marginal gaps on the approximal surfaces of the fillings using a stereomicroscope and specific probes according to the FDI criteria for restoration evaluation. Data were analysed using the Mann-Whitney U, Kruskal-Wallis, and chi-square tests. RESULTS: The median time ± interquartile range was 186 ± 80 s for the bulk-fill base technique and 463 ± 156 s for the conventional incremental technique (p < 0.001). The quality of the fillings was better for the bulk-fill base technique than for the conventional incremental technique (X2 = 9.5, p = 0.002). Neither operator experience nor the usual technique of choice were associated with the procedure time or the quality of the fillings. CONCLUSIONS: Compared to the conventional incremental technique, the use of the bulk-fill base technique shortened the time to fill a cavity by 59.8 % or 4 min and 36 s, and it improved the immediate surface and marginal quality of the fillings, regardless of the operator's experience or technique preference. CLINICAL SIGNIFICANCE: The use of the bulk-fill base technique instead of the conventional incremental technique leads to significant time-savings when placing large class II composite fillings. Additionally, the use of the bulk-fill base technique instead of the conventional incremental technique improves the immediate quality of large class II composite fillings.

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective.

Background: Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour. Methods: Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A). Results: Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP. Conclusion: EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours.

Quality of life, mentalization, and perception of challenging patient encounters in dentistry: A cross-sectional study.

OBJECTIVE: This study investigated how exposure to challenging patient encounters influenced participants' self-reported quality of life, and how participants' mentalization capabilities affected the perceptions of challenging patients encounters among Norwegian dentists and dental students. MATERIALS AND METHODS: Data was collected with an online questionnaire, and a total of 165 dentists (n = 126) and dental students (n = 39) responded. RESULTS: Participants who reported higher total exposure of challenging encounters reported lower quality of life (QoL). Mentalization tendencies affected the perception of challenging encounters with specific types of patients; critical and anxious; as well as the estimation of the total exposure to challenging patient encounters. Participants that were overconfident with regards to the mental states of others found these patient types less challenging and they reported less overall exposure to challenging patients than underconfident participants. Also, overconfident participants reported higher QoL than underconfident participants. CONCLUSIONS: Mentalization capabilities of dental practitioners interact with the perception of challenging encounters in dental practice, and how practitioners respond to these challenges. Measures should be undertaken to increase the awareness of metacognitive skills in dentistry with the dual goal of improving patient care as well as the quality of life of dental practitioners.

Delay of Dental Care: An Exploratory Study of Procrastination, Dental Attendance, and Self-Reported Oral Health.

Delay of dental care is a problem for dental public health. The present study explored the relationship between procrastination and dental attendance, focusing on delay in seeking dental care. This hypothetical relation was compared to other avoidance-related factors affecting dental attendance. In addition, an inquiry into the reasons for delaying dental care was conducted. Students (n = 164) answered an internet-based questionnaire on socio-demographic factors, dental health, dental attendance, delay of dental care, reasons for the delay, procrastination (IPS), dental anxiety (MDAS), perceived stress (PSS) and oral health self-efficacy (OHSES). The study found no significant relation between procrastination and delay in dental care. However, procrastination was related differently to past, present, and future dental attendance and seemed to relate to oral health behavior. Delay of dental care was associated with higher dental anxiety and lower oral health self-efficacy. The cost of dental care was the most frequently given reason for the delay of dental care. Further research on the delay of dental care and dental attendance is warranted in understanding the behavior, implementing interventions, and improving the utilization of public dental care.

Using storytelling in undergraduate dental education: Students' experiences of emotional competence training.

AIM: The aim of the study was to explore the use of storytelling as a teaching method for emotional competence interventions within undergraduate dental curriculum (dental and dental hygiene students). MATERIALS AND METHODS: Students participated in five sessions related to emotional competence: one theoretical and four practical. During the latter, divided in small groups, students told individually two stories: a story about a clinical situation in which they had an emotional experience and a story concerning a patient's experience of the same emotion. Each session focused on a single emotion: happiness, fear, anger and shame. A questionnaire was used to collect perceptions about enjoyment, how stories were chosen, what was learned and if the sessions were stimulating in any way. A focus group was organised to collect reflections about the learning environment, process of learning and specific skill set developed during these sessions. RESULTS: The majority of the students enjoyed listening, telling and preparing the stories. They reported to experience social support and feeling a sense of community during the sessions. The students believed that stories helped them to reflect on their clinical work and to regulate their emotional experiences more efficiently in clinical situations. Regarding the learning environment, the dental students pointed out the distinctiveness and dissimilarities between the dental and dental hygiene students, but also expressed that they had a desire to learn more about the other student group. CONCLUSION: Storytelling used as part of an emotional competence course appears to have benefits for students' reflection about their role as dental health professionals. This teaching method was well-perceived by the students included in this study.

Top-down self-regulation processes as determinants of oral hygiene self-care behaviour: A systematic scoping review.

OBJECTIVES: Understanding the psychological mechanisms that moderate oral hygiene self-care behavior is anticipated to benefit efforts to change such behavior. Top-down self-regulatory (TSR) processes represent one group of relatively unexplored, yet potentially influential, moderating factors. This systematic scoping review aims to explore whether there is evidence that TSR processes moderate oral hygiene self-care engagement within the current literature. METHODS: CINAHL, The Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched up to April 2020 for articles that compared measures of TSR processes (such as self-monitoring, inhibitory control, and task switching) to oral hygiene self-care behavior, or tested interventions that aimed to change or support TSR processes. RESULTS: The search returned 6626 articles, with 25 included in the final sample. Weak evidence supported both the role of TSR processes as moderators of interdental cleaning and the value of interventions targeting self-monitoring of interdental cleaning behavior. Overall, methodological limitations rendered the findings somewhat inconclusive, with an absence of objective assessments of TSR capacity, and little focus on TSR processes as moderators of intervention effects. CONCLUSIONS: The inconclusive, but reasonably promising, findings point to the value of continuing to apply TSR processes within studies of oral hygiene behavior. Exploring why interdental cleaning appears more reliant on TSR processes than toothbrushing, employing objective neuropsychological assessment, and measuring TSR constructs within interventions targeting TSR processes, are encouraged. As a scoping review, the study hopes to generate interest and serve as a starting point for further investigation.

Challenging encounters in clinical dentistry: a qualitative study investigating online reviews of patient satisfaction with Norwegian dentists.

OBJECTIVE: Mapping key themes that characterize challenging and positive encounters in dental practice using online reviews of patient satisfaction. MATERIALS AND METHODS: 11,764 online patient reviews of dental encounters, consisting of an overall satisfaction rating (1-5 stars) and a free-text response, were collected from the web-site Legelisten.no. The reviews were split into two sets: reviews from patients with low satisfaction (1-2 stars) representing challenging encounters vs. patients with high satisfaction (4-5 stars) representing positive encounters. A qualitative thematic analysis was used to analyse the text materials in the datasets. RESULTS: Five key themes to both challenging and positive patient encounters were identified: (1) Interpersonal factors, (2) Patient factors, (3) Dentist factors, (4) Situational factors, and (5) Consequences. These themes are discussed in light of their role in challenging and positive patient encounters, as well as previous studies of online reviews and patient satisfaction. CONCLUSIONS: Based on the patients' experiences with dental encounters, challenging encounters seem to arise when dentists' personality traits and communication skills fail to match the patients' expectations or preferences. It appears central to patient satisfaction that dentists are able to shift between different communication styles in order to adapt to the personality and preferences of the patients.

Perceived Stress and Associated Factors in Russian Medical and Dental Students: A Cross-Sectional Study in North-West Russia.

The aim was to assess perceived stress (PS) and factors associated with PS in Russian medical and dental students. A total of 406 medical and 283 dental students aged 18-25 years that attended the Northern State Medical University in Arkhangelsk, North-West Russia participated in this cross-sectional study. A structured, self-administered questionnaire was used to collect information on socio-demographic and socioeconomic factors, oral health (OH) behavior, and self-reported OH. All students were clinically examined to assess dental caries, oral hygiene, and gingiva. PS was measured by the Perceived Stress Scale 10 (PSS-10). Of the students, 26.0%, 69.1%, and 4.9% reported low, moderate, and high PS, respectively. Female sex (b = 2.28, 95% confidence interval (CI): 1.38-3.18), dental faculty (b = 1.74, 95% CI: 0.94-2.54), low subjective socioeconomic status (SES) (b = 1.71, 95% CI: 0.91-2.51), and irregular dental visits (b = 1.65, 95% CI: 0.72-2.58) were associated with higher PSS-10 score. These factors were assumed to be clinical meaningful, given that minimal clinically important difference of PSS-10 fell between 2.19 and 2.66 points. The majority of the medical and dental students reported moderate PS. Based on statistical significance and clinical meaningfulness, socio-demographic factors (sex, faculty), subjective SES, and OH behavior (regularity of dental visits) were associated with PS.

Special Issue on E-Health Services.

The importance of e-health to citizens, patients, health providers, governments, and other stakeholders is rapidly increasing. E-health services have a range of advantages. For instance, e-health may improve access to services, reduce costs, and improve self-management. E-health may allow previously underserved populations to gain access to services. Services utilizing apps, social media, or online video are rapidly gaining ground in most countries. In this special issue, we present a range of up-to-date studies from around the world, providing important insights into central topics relating to e-health services.

Differences in Emotional and Pain-Related Language in Tweets About Dentists and Medical Doctors: Text Analysis of Twitter Content.

BACKGROUND: Social media provides people with easy ways to communicate their attitudes and feelings to a wide audience. Many people, unfortunately, have negative associations and feelings about dental treatment due to former painful experiences. Previous research indicates that there might be a pervasive and negative occupational stereotype related to dentists and that this stereotype is expressed in many different venues, including movies and literature. OBJECTIVE: This study investigates the language used in relation to dentists and medical doctors on the social media platform Twitter. The purpose is to compare the professions in terms of the use of emotional and pain-related words, which might underlie and reflect the pervasive negative stereotype identified in relation to dentists. We hypothesized that (A) tweets about dentists will have more negative emotion-related words than those about medical doctors and (B) pain-related words occur more frequently in tweets about dentists than in those about medical doctors. METHODS: Twitter content ("tweets") about dentists and medical doctors was collected using the Twitter application program interface 140Dev over a 4-week period in 2015, scanning the search terms "dentist" and "doctor". Word content of the selected tweets was analyzed using Linguistic Inquiry and Word Count software. The research hypotheses were investigated using nonparametric Wilcoxon-Mann-Whitney tests. RESULTS: Over 2.3 million tweets were collected in total, of which about one-third contained the word "dentist" and about two-thirds contained the word "doctor." Hypothesis A was supported since a higher proportion of negative words was used in tweets about dentists than in those about medical doctors (z=-10.47; P<.001). Similarly, tests showed a difference in the proportions of anger words (z=-12.54; P<.001), anxiety words (z=-6.96; P<.001), and sadness words (z=-9.58; P<.001), with higher proportions of these words in tweets about dentists than in those about doctors. Also, Hypothesis B was supported since a higher proportion of pain-related words was used in tweets about dentists than in those about doctors (z=-8.02; P<.001). CONCLUSIONS: The results from this study suggest that stereotypes regarding dentists and dental treatment are spread through social media such as Twitter and that social media also might represent an avenue for improving messaging and disseminating more positive attitudes toward dentists and dental treatment.

Changes in dental anxiety among 15- to 21-year-olds. A 2-year longitudinal analysis based on the Tromsø study: Fit futures.

OBJECTIVE: Identify predictive variables related to the development and continuation of high dental anxiety among young people over 2 years and assess differences between youth experiencing increased, decreased or unchanged dental anxiety scores over time. METHODS: An observational panel study of 15- to 21-year-old people in Tromsø and Balsfjord region followed students from their first to their last year of upper secondary school (2010/11-2012/13). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) of possible predictive variables assessed at baseline when using dental anxiety score from the second wave as a dichotomous dependent variable. Variables measured at baseline: Sex, Dental Caries Experiences (DMFS index), Dental Anxiety (Corah's Dental Anxiety Scale/DAS), Psychological Distress (Hopkins Symptom Checklist/HSCL-10), Avoidance of dental treatment, Pain Estimation at the dentist and motivational questions related to tooth brushing and caries (Self and Social Motivation). Wilcoxon signed-rank tests and Kruskal-Wallis tests were used to test whether changes in DAS score between waves were associated with changes in Pain Estimation between waves and HSCL-10 scores at baseline. RESULTS: Hopkins Symptom Checklist, DMFS and DAS scores at baseline predicted high dental anxiety scores after 2 years. Sex, motivation related to oral hygiene and avoidance due to fear at baseline did not contribute significantly to our model. DMFS and HSCL-10 were higher among young people who reported a substantial change in DAS score (2.0 > Interquartile range/IQR), irrespective of the direction of change. Pain Estimation changed consistently with a change in DAS score. CONCLUSION: Mental health symptoms, pre-existing dental anxiety and dental health status are important contributors to the development of dental anxiety in youth. Estimations of pain at the dentist are central when it comes to changes in dental anxiety over time in this study.

Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures.

OBJECTIVE: To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents. MATERIALS AND METHODS: We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15-18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah's DAS as a dichotomous dependent variable. RESULTS: Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, 'external control belief', avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12). CONCLUSIONS: Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.

Media preferences in scenarios involving relationship closeness and information valence: evidence of strategic self-presentation and sex differences.

The study investigated strategic self-presentation (relationship closeness, information valence, and sex) on hypothetical choice of media used. 145 participants (73 women, 72 men; M age = 22.3 yr.) were randomly assigned to experimental conditions where they indicated their preference for communicating with either a friend or a stranger using Short Messaging Service (SMS), e-mail, or telephone, compared to face-to-face. Information valence was manipulated as a within-subjects variable by scenarios where information was self-referential and either negative or positive. Preference to mediated channels in the two scenarios was measured as an average of self-reported scores on a scale from 1-5 where 3 indicated face-to-face communication. Relationship closeness and scenario affected media preferences. Participants had higher preference scores for mediated channels when communicating with strangers than with friends and when sharing self-referential and negative information. Only women's preferences appeared to be affected by the manipulation of relationship closeness.

Language of motivation and emotion in an internet support group for smoking cessation: explorative use of automated content analysis to measure regulatory focus.

The present study describes a novel approach to the identification of the motivational processes in text data extracted from an Internet support group (ISG) for smoking cessation. Based on the previous findings that a "prevention" focus might be more relevant for maintaining behavior change, it was hypothesized that 1) language use (ie, the use of emotional words) signaling a "promotion" focus would be dominant in the initiating stages of the ISG, and 2) that the proportion of words signaling a prevention focus would increase over time. The data were collected from the ISG site, spanning 4 years of forum activity. The data were analyzed using the Linguistic Inquiry and Word Count application. The first hypothesis - of promotion focus dominance in the initiating stages - was not supported during year 1. However, for all the other years measured, the data showed that a prevention failure was more dominant compared with a promotion failure. The results indicate that content analysis could be used to investigate motivational and language-driven processes in ISGs. Understanding the interplay between self-regulation, lifestyle change, and modern communication channels could be of vital importance in providing the public with better health care services and interventions.

Language use in an internet support group for smoking cessation: development of sense of community.

The use of the internet for health purposes is increasing, as is the number of sites and online communities aimed at helping people to stop smoking. Some of the effects of online communities may be mediated through a sense of community. By using the computer-program Linguistic Inquiry and Word Count with a Norwegian dictionary, we investigated whether there was a development of sense of community in a forum related to a Norwegian smoking cessation intervention, by examining the use of self-referencing vs. collective referencing words. Data from a 4-year period, including in total 5242 web pages, were included. There was a significant increase in the use of collective words over time and a significant decrease in the use of self-referencing words. The increase in the use of collective words suggests that there appears to be a development of a sense of community in the forum over time. More research is needed to study the importance of an online sense of community.

Using noninferiority tests to evaluate telemedicine and e-health services: systematic review.

BACKGROUND: An increasing number of studies within the field of telemedicine and e-health are designed as noninferiority studies, aiming to show that the telemedicine/e-health solution is not inferior to the traditional way of treating patients. OBJECTIVE: The objective is to review and sum up the status of noninferiority studies within this field, describing advantages and pitfalls of this approach. METHODS: PubMed was searched according to defined criteria, and 16 relevant articles were identified from the period 2008-June 2011. RESULTS: Most of the studies were related to the fields of psychiatry and emergency medicine, and most were published in journals relating to these fields or in general scientific or general medicine journals. All the studies claimed to be noninferiority studies, but 7 out of 16 tested for statistical differences as a proxy of noninferiority. CONCLUSIONS: The methodological quality of the studies varied. We discuss optimal procedures for future noninferiority studies within the field of telemedicine and e-health and situations in which this approach is most appropriate.

Physician response time when communicating with patients over the Internet.

BACKGROUND: Patients want to use electronic communication to access health services more easily. Health authorities in several countries see this as a way to improve health care. Physicians appear to have conflicting opinions regarding the suitability of electronic communication in clinical settings. OBJECTIVES: The aim of our study was to measure how long it actually takes physicians to answer questions from patients through an electronic communication channel, and whether some of the questions are especially time consuming. METHODS: We monitored electronic patient-physician communication. A total of 1113 messages from 14 participating physicians from 7 medical offices were analyzed. The length of questions and answers, and the time physicians spent answering the questions were recorded and analyzed. RESULTS: Physicians spent an average of 2.3 minutes (median 2 minutes) answering questions from patients. The patients' questions had an average length of 507.1 characters (95% CI 487.4-526.9, SD 336.2), while physicians' answers averaged 119.9 characters (95% CI 189.8-210.0, SD 172.6). The results show that the influence of patient question length on time spent responding was negligible. For the shortest 25% of the questions the answer time was 2.1 minutes (95% CI 1.9-2.3), while it was 2.4 minutes (95% CI 2.2-2.7) for the longest 25%. Even extremely long questions had a minimal impact on the time spent answering them. A threefold increase in question length from patients resulted in only an 18% increase in physician response time. CONCLUSIONS: The study shows the potential clinical usefulness of electronic communication between patients and health care services by demonstrating the potential for saving time.

Bridging the gap between patients' expectations and general practitioners' knowledge through disease surveillance.

In this paper we have investigated "to what degree patients trust their regular doctor to be fully informed about the prevalence of infectious diseases in their neighbourhood", and what general practitioners (GPs) actually know. A representative sample of one thousand Norwegians (potential patients) was interviewed by telephone, and 13 GPs were interviewed individually or in focus groups. Nearly half of the patients trusted their GP to be more or less "fully informed" about the prevalence of infectious diseases in their neighbourhoods, while the GPs in reality were not well informed. We conclude that new surveillance solutions are needed. One promising approach is electronic retrieval of symptom data directly from patients.