INTRODUCTION The literature indicates different factors influencing recruitment of health professional students to work in rural areas. The purpose of this study is to explore the willingness of health profession students in the Faculty of Medicine Foca, University of East Sarajevo, Bosnia and Herzegovina to work in a rural area following graduation and the factors influencing incentives to pursue a rural career. METHODS The cross-sectional study included first-year through sixth-year students aged 18 years or older and enrolled in one of three study programs at the Faculty of Medicine: medicine, dentistry and nursing. The questionnaire was distributed at the beginning of the winter semester during the first required lecture for each year and study program class. Data was analyzed using student t-test, analysis of variance when appropriate, Kruskal-Wallis test and multivariate logistic regression analysis. RESULTS A total of 519 students participated, an 88.3% response rate. Three hundred and ninety-nine (77%) participants responded positively to the question 'When you complete your studies, would you be inclined to accept a job in a rural region?' Factors associated with willingness to practise in rural areas included being female (p=0.027) and having a rural upbringing (p=0.037). Significant differences between medicine, nursing and dentistry students were found in their opinion that willingness to work in rural practice depends greatly on the possibility to get residency more easily (p=0.001). Compared to their peers, nursing students had better opportunities to attend national courses cost-free (p=0.027) and to be involved in the education of new generations of health profession students (p=0.001). Getting a post in an urban area after a work period in a rural area was most valued as an incentive by dentistry students (p=0.037). The multivariate logistic regression model was used to analyze predictors of willingness to practise in rural areas. Students who had been raised in a rural community (p=0.042) as well as female students (p=0.016) were more likely to accept rural practice. Statistical significance at an alpha level of 0.05 was not reached for study program and year of study. CONCLUSIONS The results of the study showed a high willingness of medicine, dentistry and nursing students to work in rural areas following graduation. Female students and students who were raised in a rural community were more likely to choose a rural career. Stakeholders should be committed to strengthening the rural deployment of health professionals by creating a more attractive, rural environment.

There are many factors that can cause damage to the temporomandibular joint (TMJ) structures or impair normal functional relationships between condyle, disc and eminence. The main symptoms associated with TMJ dysfunction are pain, limited mobility of the mandible, spasticity of the masticatory muscles and sound that is produced in the joint during mandibular movement. Pain originates from nociceptors located in soft tissue of the joint. If the soft tissue structures are not in inflammation, the pain is sharp, sudden and intense tightly connected to the movements in the TMJ. If the inflammation is presented, the pain is constant and increases with the movements in the joint. TMJ dysfunction is manifested by feeling stiffness of the joint, limited and/or altered opening of the mouth with deviation or deflection of the mandible. Individual or multiple sound produced by the TMJ are most often the consequence of the disturbed function of the condyle-disc complex, the morphological incompatibility of the joint surfaces or degenerative changes in them. The signs and symptoms of disease and dysfunction of TMJ are different and depend on the duration of the disorders and its chronicity as well as on the individual sensitivity of the patients. Proper identification of symptoms and precise diagnosis are therefore essential for future treatment.

OBJECTIVES Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. METHODS The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants' knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). RESULTS No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. CONCLUSION The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.

Abstract Introduction The purpose of the present study was to examine self-perceived stress of health professions students at the Faculty of Medicine Foča, and to explore its association with anxiety, depression and health-related quality of life. Methods The cross-sectional study enrolled 451 students at the Faculty of Medicine (medicine, dentistry, nursing and speech therapy). Survey instruments were distributed at the conclusion of the spring semester during the last required lecture for each year and study programme class. Perceived stress was assessed using the 14-item Perceived Stress Scale. The students were evaluated for symptoms of depression and anxiety, using Zung’s self-assessment inventory for depression and the Spielberger State-Trait Anxiety Inventory (STAI). European Quality of Life-5 dimensions were used for describing and evaluating health. Multivariate analyses were carried out using logistic regression to examine the relationship between the outcome variable and selected determinant factors. Results A high degree of stress was reported by 1.6% of students, while the majority of students had either moderate (70.6%) or low degree (27.5%) of stress. The significant independent factors associated with perceived stress were anxiety score (OR, 0.339; CI 95%, 0.276-0.403) and EQ-5D score (OR, 0.044; CI 95%, 0.033-0.085). A high degree of perceived stress (OR, 0.624; CI 95%, 0.507-0.704), the presence of depression (OR, 0.800; CI 95%, 0.513-1.087), and low quality of life were associated with anxiety (OR, 0.073; CI 95%, 0.018-0.128). Conclusion Higher levels of perceived stress predispose health professions students for anxiety and lower quality of life. The study programme was not a significant determinant of perceived stress sore.

Maja N. Račić1, Srebrenka H. Kusmuk1, Srđan R. Mašić1, Nedeljka M. Ivković2, Vedrana R. Joksimović1, Jelena M. Matović1 1Department for primary health care and public health, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina 2Department of Dentistry, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina Impact of the physician-patient relationship on the treatment outcomes of arterial hypertension Оригинални радови / Original Articles

Đorđe Božović1, Nedeljka Ivković1, Maja Račić2, Siniša Ristić3 1University of East Sarajevo, Faculty of Medicine, Department of Oral Rehabilitation, Foča, Republic of Srpska, Bosnia and Herzegovina; 2University of East Sarajevo, Faculty of Medicine, Department for Primary Care and Public Health, Foča, Republic of Srpska, Bosnia and Herzegovina; 3University of East Sarajevo, Faculty of Medicine, Department of Basic Medical Sciences – Physiology, Foča, Republic of Srpska, Bosnia and Herzegovina

SUMMARY Stress is defined as a state in which homeostasis, as a dynamic balance of internal conditions necessary for the proper functioning of cells or the living organism as a whole, is affected by the action of various stressors. Stress reaction occurs as a result of stress system activities, which is located in the central and peripheral nervous system. Stress evaluation involves a qualitative and quantitative analyses and valuation of certain biologically active substances (biomarkers of stress) in body fluids that are so often associated with stress. Saliva as a diagnostic medium is being increasingly used for purposes of clinical and basic research because of its composition and content as well as the advantages of the process of sampling, as compared to traditional methods of collecting blood samples and urine samples. Cortisol, as a biomarker of stress, is the most often studied salivary biomarker, which is associated with the activation of the hypothalamic-pituitaryadrenal (HPA) axis. Since stress leads to the suppression of the immune system, values of salivary secretory IgA and salivary lysozyme, as biomarkers of stress, can be analyzed. In saliva, it is difficult to monitor acute stress parameters, catecholamines, due to their low concentrations, rapid degradation and instability in the samples. Chromogranin A (CgA) and α-amylase enzyme can be used as alternative indices of adrenergic activity during stress reactions, due to their stability in saliva and reliability of the obtained values. Stress reaction and the diseases in whose pathogenesis it participates are yet another proof of the constant interaction of physical, psychological and social factors in health / disease SAŽETAK Stres se definiše kao stanje u kome je homeostaza, kao dinamička ravnoteža unutrašnjih uslova neophodnih za pravilno funkcionisanje ćelija ili živog organizma u cjelini, ugrožena djelovanjem različitih stresora. Stresna reakcija nastaje kao posljedica aktivnosti tzv. stres sistema, koji je smješten u centralnom i perifernom nervnom sistemu. Stres sistem, preko odgovarajućih medijatora, stimuliše kataboličke, lipolitičke, antireproduktivne i imunosupresivne efekte stresne reakcije s ciljem preusmjeravanja energije zbog povećane potrebe organizma u trenutku značajnim za njegovo preživljavanje. Evaluacija stresa podrazumijeva kvalitativno i kvantitativno analiziranje i vrednovanje određenih biološki aktivnih komponenti (biomarkera stresa) u tjelesnim tečnostima koje se dovode u vezu sa stresom. Pljuvačka se kao dijagnostički medijum sve češće koristi za klinička i bazična istraživanja zbog mogućnosti koje pruža, s obzirom na njen sastav i sadržaj kao i na prednosti samog procesa uzorkovanja u odnosu na tradicionalne metode prikupljanja uzoraka krvi i urina. Od biomarkera stresa, u pljuvački je najčešće ispitivan kortizol, koji se dovodi u vezu sa aktivacijom hipotalamus-hipofiza-adrenalne (HPA) osovine. S obzirom da stres dovodi do supresije imunog sistema, u pljuvački se mogu analizirati i vrijednosti sekretornog IgA i lizozima kao biomarkera stresa. Parametre akutnog stresa, kateholamine, teško je pratiti u pljuvački zbog njihove male koncentracije, brze degradacije i nestabilnosti u uzetim uzorcima. Kao alternativni indeksi adrenergičke aktivnosti tokom stresne reakcije, zbog stabilnosti u pljuvački i pouzdanosti dobijenih vrijednosti, mogu se koristiti hromogramin A (CgA) i enzim α-amilaza. Stresna reakcija i oboljenja u čijoj etiopatogenezi ona učestvuje još su jedan dokaz stalne interakcije fizičkih, psihičkih i socijalnih faktora u zdravlju/bolesti

Abstract Background/purpose The purpose of the study was to investigate relationship between saliva flow rates, estrogen levels, and caries prevalence in female psychiatric patients under antipsychotic therapy. Materials and methods Sixty-one institutionalized psychiatric females (31 patients treated with chlorpromazine only and 30 patients treated with chlorpromazine and biperiden) were compared with 36 unmedicated healthy females. The unstimulated whole saliva (UWS) flow rate and serum estrogen were measured. Caries prevalence was recorded in terms of decayed, missing, and filled teeth (DMFT). Results The UWS flow rate in the control group was 0.35 ± 0.18 mL/min and the DMFT 18.8 ± 5.7. In comparison, UWS flow rates were 0.25 ± 0.15 mL/min (P = 0.003) and 0.07 ± 0.05 mL/min (P = 0.000) in patients on chlorpromazine and patients on chlorpromazine as well as biperiden, respectively, and DMFT values were 22.7 ± 4.6 (P = 0.003) and 26.5 ± 5.3 (P = 0.000), respectively. Patients on chlorpromazine with amenorrhea had reduced UWS flow rate and estrogen levels with respect to controls (P = 0.036; P = 0.000, respectively). Correlation analysis revealed significant correlations between UWS flow rate and DT, DMFT, number of used drugs and estrogen level. Conclusion It seems that chlorpromazine-induced hyposalivation included (apart from its antimuscarinic effect) a neuroendocrine effect which affected the estrogen levels.

Acrylic based resins are frequently used in daily dental practice. The most common use of the materials includes denture bases and denture liners, temporary crowns and orthodontic appliances. In the mouth, properties and functional efficiency of applied acrylic resins depend on internal factors related to the methods and conditions of polymerization and on external factors that are related to the environment in which the material is placed. Residual monomer, which is released as a result of interaction of both sets of factors is often associated with irritation, inflammatory and allergic reactions of oral mucosa. The aim of this paper is to review literature dealing with the conditions of polymerization and biodegradation of acrylic resins under certain conditions in the oral cavity and their impact on oral health (reviewed literature available on Medline database during the past two decades.) Conclusion: Methods and conditions of acrylate polymerization, on the one hand, and properties of saliva, chewing and the presence of microorganisms in the oral cavity, on the other hand, can be considered responsible for the release of residual monomers. Clinically significant events followed by redness and erosion of the oral mucosa, burning sensation and burning mucosa and tongue, may be due to the effects of released, potentially cytotoxic, residual monomers.