Research Article

Assessment of suboptimal status and their associated risks in university students: A cross-sectional study, UAE Saba Saleh Al-Hemyari1*, Ammar Abdulrahman Jairoun2, Naseem Abdulla2

ABSTRACT

Objective: Suboptimal health status (SHS) is an intermediate stage between and health and is regarded as a subclinical characterized by a decline in vitality, in physiological function and the capacity for adaptation. The objectives of this study were to assess the SHS and to investigate a variety of factors associated with SHS in university students. Materials and Methods: A cross-sectional study was conducted over 3 months from January 2017 to March 2017 among Ajman University students. A random sample of medical students was recruited from both first and final study years. Results: The results of this study showed that half of the students (52.5%) gave higher SHS score and (47.5%) of them gave a lower score. Moreover, age between 15 and 19 and first years students was found to be significantly associated with higher SHS score (P = 0.002), (P = 0.000), respectively. Conclusion: The results of the study emphasized the importance of introducing a health promotion and counseling program that begin early in the medical colleges to screen early stage illness.

KEY WORDS: Suboptimal health status, University students, Medical students

INTRODUCTION treatment plan. SHS is similar to this concept by assessing the health status and providing effective The health status of university student is one of the strategies for improvement of health, prevention of major public health issues around the world. Medical disease and the treatment of early stage illness. In the colleges are considered as stressful and demanding recent years, the concept of SHS has been widely used environment. There has been a growth interest in the in many other countries, including Japan,[4] Canada,[5] assessment of health status of the student. In one study and Australia.[6] Acquiring and compiling knowledge among 381 Iranian students, 61.9% of students had about the health status of the medical students is an [1] healthy status. In another study including 2103 college important step in creating health promotion program students from universities in Germany, Bulgaria, and to meet the needs and concerns of university students Poland, 8.7% of the participants rated their health as and to provide counseling and interventions aimed to excellent, 35.8% reported it as very good, 45.6% as improve students health status in the future. To our good, 8.9% as fair, and 1% felt that their health was knowledge, there was no study conducted in Arab [2] poor. Further study among a random sample of 171 countries as well as in Gulf Cooperation Council Venezuelan pharmacy students showed good overall countries particularly in UAE assessing the health [3] health status of pharmacy students. Suboptimal status of university students. The present study, health status (SHS) can be defined as intermediate therefore, aimed to assess SHS and to investigate a stage between the illness and the health and its variety of factors associated with SHS in university considered as a subclinical, reversible stage of chronic students. disease. Prevention, prediction, and personalization of medicine are the aim of the any integrated preventive MATERIALS AND METHODS

Access this article online Study Design and Study Setting This study was a cross-sectional descriptive-analytical Website: jprsolutions.info ISSN: 0974-6943 research conducted in Ajman University (AU) from

1Department of Clinical Pharmacy, Ajman University, Ajman, UAE, 2Department of Public Health and Safety, Consumer Product Safety Section, Dubai Municipality, UAE

*Corresponding author: Saba Saleh Al-Hemyari, Department of Clinical Pharmacy, Ajman University; Ajman, UAE. E-mail: [email protected]

Received on: 23-05-2017; Revised on: 27-06-2017; Accepted on: 26-07-2017

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January to March 2017 among 505 first to fourth were calculated for each respondent by summing the academic year students of medical colleges (Pharmacy grading for the 25 items. Internal consistency of the and dentistry). subscales proved to be good. The Cronbach’s alpha coefficients of SHSQ-25 were 0.91.[7] Inclusion and Exclusion Criteria Participants had to meet the following inclusion Validation and Pre-testing of Questionnaire criteria: (1) No history of somatic or psychiatric Before the study, the questionnaire was validated disease or any other chronic illness, (2) no history by subject experts for its content and relevance. of medication consumption in the previous 2 weeks, Furthermore, it was field-tested several times on a (3) participants should belong to AU, (4) participants pilot sample of 100 students to clarify any ambiguities from medical sciences should range in between the and to determine the reliability of the questionnaire. first to the fourth year of study, and (5) willing to participate in the study. We excluded students who Ethical Principles have a specific disease related to cardiovascular The study was approved by University Research system, respiratory system, genitourinary system, Ethical Committees and approval letter was obtained digestive system, hematic system, and diabetes. It was to allow the researcher to distribute and collect ascertained that the participant’s students do not suffer the questionnaires among AUST students. The from any chronic or have a history of somatic participation of the students in this study was entirely or psychiatric disease through their own medical files Table 1: Demographic characteristics of the students at the clinic university. In addition, before starting distribution of the study questionnaire, the students Demographic characteristics F, n=505 (%) were asked if they suffer from any health problems Age or chronic diseases and if they consumed medication 15‑19 200 (39.6) 20‑24 285 (56.4) in the previous 2 weeks. The individuals who did not 25‑29 6 (1.2) meet these criteria were excluded. 30‑35 13 (2.6) >35 1 (0.2) Sample Size Estimation and Sampling Methods Gender Male 145 (28.7) Simple random sample was used as the sampling Female 360 (71.3) method. According to Admission and Registration Study year First 61 (12.1) directory, the estimated total number of medical Second 203 (40.2) students was 1000 students distributed across Third 61 (12.1) pharmacy and dentistry colleges. We expect the Fourth 127 (25.1) Fifth 53 (10.5) prevalence rate to be around 35%. The alpha level is Marital status set to 5% so that we have a 95% confidence interval. Married 33 (6.5) The precision (D) of the 95% confidence interval is Single 472 (93.5) Total monthly income fixed to be 5% so that the width of the 95% CI will <5000 AED 91 (18.0) be at maximum 10%. According to the assumptions 5000‑<10000 AED 83 (16.4) above, the minimum sample size required was n = 501 10000‑<20000 AED 252 (49.9) 20000>AED 79 (15.6) participants if we assume a non-response rate around Nationality 30%. The final chosen sample size was 505 students. UAE national 24 (4.8) Non UAE national 481 (95.2) Measurement Instruments Health insurance coverage Yes 262 (51.9) A selfadministered questionnaire was used as a tool to No 243 (48.1) collect the data from the participants. The questionnaire Physical activity/week was comprised two main parts: Sociodemographic and ˂1 h 106 (21.0) 1‑2 h 46 (9.1) lifestyle factors and SHSQ-25 questionnaire was used 3‑4 h 174 (34.5) to assess the respondent’ SHS. The participants were ≥5 h 179 (35.4) asked to indicate how often they had experience any Current smoking Yes 54 (10.7) of various specific complaints in the last 3 months. No 451 (89.3) The 25 items related to SHS were categorized into five Height subscales: (9 items), cardiovascular system Mean±SD 165.3±9.43 Weight (3 items), digestive tract (3 items), immune system (3 Mean±SD 65.4±15.56 items), and mental status (7 items). These items were BMI rated on 5-points Likert scale (1= “never or almost Mean±SD 23.85±5.21 Normal 302 (59.8) never,” 2 = “occasionally,” 3 = “often,” 4 = “very Overweight 98 (19.4) often,” and 5 = “always”). The raw scores of 1-5 on Obese 105 (20.8) the questionnaire were recoded as 0-4. SHS scores SD: Standard deviation

Journal of Pharmacy Research | Vol 11 • Issue 8 • 2017 933 Saba Saleh Al-Hemyari et al. voluntary and without compensation. Before data of students in different groups with respect to age, collection, the purpose of the survey was explained, gender, study year, marital status, total monthly income, and they were also informed that the completion and nationality, health insurance coverage, physical activity, submission of the questioner would be taken on their smoking status, height, and weight. consent and all students signed the informed consents. Assessment of SHS Among Study Participants Statistical Analysis SHSQ-25 was our tool to assess the SHS of the On the receipt of survey forms, data were checked for students. It is a 25-item instrument that includes five completeness and consistency then coded data were dimensions: “Fatigue” (9 items), “mental health” entered and analyzed using the Statistical Package for (7 items), “immune system” (3 items), “cardiovascular Social Sciences version 23. Data were summarized system” (3 items), and “digestive system” (3 items). using mean and standard deviation values for sub The participants were asked to rate their behaviors on optimal health scores, number and percentage for a five-point Likert type scale (1 = “never or almost categorical variables. Comparison between the never,” 2 = “occasionally,” 3 = “often,” 4 = “very groups was done using independent t-test and one- often,” and 5 = “always”). The raw scores of 1-5 on the way ANOVA tests for scores. The level of statistical questionnaire were recoded as 0-4. SHS scores were significance was defined as P < 0.05. calculated for each respondent by summing the grading for the 25 items. The participants were divided into two RESULTS groups by the median SHS score of 31, high SHS score group (SHS score ≥31) and low SHS score group (SHS Sociodemographic Characteristics of the Participants <31). The mean SHS score among the SHS group was This cross-sectional study was conducted among medical 33.3 ± 14.4 overall, 265 (52.5%) respondents gave student (Dentistry and pharmacy) of AU to determine: higher SHS score and 240 (47.5%) gave lower score. The prevalence of self-perceived , SHS and their Table 2 summarizes the frequency (%) of each of the risk factors among medical students also, to examine questions related to SHS questionnaire. the relationship between the stress and SHS of medical students. The survey was conducted from January to Factors Associated with Student’ SHS March 2017. A total of 505 students participated in this Table 3 summarizes the bivariate analysis in which study. Table 1 summarizes the frequency and percentage SHSQ-25 score dependent variable is tabulated against

Table 2: Student’ Suboptimal health status (SHSQ‑25) How often is it, that you (your) n (%) Never or Occasionally Often Very often Always almost never Exhausted without greatly increasing your physical 73 (14.5) 276 (54.7) 76 (15.0) 63 (12.5) 17 (3.4) activity Your fatigue could not be substantially alleviated 78 (15.4) 207 (41.0) 99 (19.6) 93 (18.4) 28 (5.5) by rest You were lethargic when working 29 (5.7) 169 (33.5) 152 (30.1) 122 (24.2) 33 (6.5) You suffered from headaches 49 (9.7) 203 (40.2) 96 (19.0) 120 (23.8) 37 (7.3) You suffered from dizziness 129 (25.5) 223 (44.2) 81 (16.0) 60 (11.9) 12 (2.4) Your eyes ached or were tired 125 (24.8) 215 (42.6) 85 (16.8) 51 (10.1) 29 (5.7) You suffered from a sore throat 114 (22.6) 231 (45.7) 107 (21.2) 46 (9.1) 7 (1.4) Your muscles or joints felt stiff 109 (21.6) 204 (40.4) 103 (20.4) 69 (13.7) 20 (4.0) You have pain in your shoulder/neck/waist 83 (16.4) 189 (37.4) 118 (23.4) 77 (15.2) 38 (7.5) You have a heavy feeling in your legs when 197 (39.0) 187 (37.0) 76 (15.0) 39 (7.7) 6 (1.2) walking You feel out of breath while sitting still 253 (50.1) 151 (29.9) 64 (12.7) 27 (5.3) 10 (2.0) You suffered from chest congestion 249 (49.3) 169 (33.5) 6 (12.1) 22 (4.4) 4 (0.8) You were bothered by heart palpitations 164 (32.5) 182 (32.0) 78 (15.4) 61 (12.1) 20 (4.0) Your appetite is poor 154 (30.5) 194 (38.4) 83 (16.4) 56 (11.1) 18 (3.6) You suffered from heartburn 217 (43.0) 183 (36.2) 50 (9.9) 39 (7.7) 16 (3.2) You suffered from nausea 162 (32.1) 219 (43.4) 80 (15.8) 26 (5.1) 18 (3.6) You could not tolerate the cold 118 (23.4) 177 (35.0) 88 (17.4) 69 (13.7) 53 (10.5) You had difficulty falling asleep 83 (16.4) 187 (37.0) 102 (20.2) 75 (14.9) 58 (11.5) You had trouble with waking up during night 115 (22.8) 175 (34.7) 107 (21.2) 65 (12.9) 43 (8.5) You had trouble with your short‑term memory 98 (19.4) 176 (34.9) 121 (24.0) 71 (14.1) 39 (7.7) You could not respond quickly 174 (34.5) 196 (38.8) 81 (16.0) 35 (6.9) 19 (3.8) You had difficulty concentrating 70 (13.9) 232 (45.9) 110 (21.8) 62 (12.3) 31 (6.1) You were distracted for no reason 106 (21.0) 201 (39.8) 92 (18.2) 67 (13.3) 39 (7.7) You felt nervous or jittery 63 (12.5) 169 (33.5) 124 (24.6) 97 (19.2) 52 (10.3) You caught a cold in the past 3 months 161 (31.9) 220 (43.6) 71 (14.1) 42 (8.3) 11 (2.2)

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Table 3: Factors associated with Student’ SHS is imperative in development of health promotion SHS score plan to meet the needs, and concerns of university students. In this regard, several studies using different Variables n (%) Mean±SD P value measures have reported the health status among Age medical students. Some studies assessed students’ 15‑19 200 (39.6) 35.6±14.4 0.002* 20‑24 285 (56.4) 32.3±14.0 health and associated physical, psychological, 25 year 20 (4.0) 25.7±14.8 studying, and sociodemographic factors using self- Gender rated health status.[8-11] Another study assessed the Male 145 (28.7) 31.5±15.3 0.081 Female 360 (71.3) 34.1±13.9 general health status of Iranian students using General Study year Health Questionnaire-28.[1] However, in this study, we First years 264 (52.3) 35.5±14.6 0.000* assessed the SHS of the medical students using the Final years 241 (47.7) 30.9±13.7 SHSQ-25 self-reported questionnaire. Marital status Married 33 (6.5) 35.4±15.7 0.397 Single 472 (93.5) 33.2±14.3 SHS can be defined as an intermediate stage between Total monthly disease and health, and it is regarded as a subclinical, income reversible stage of chronic disease. The present study <5000 AED 91 (18.0) 31.8±16.4 0.133 5000‑<10000 83 (16.4) 36.3±12.9 assessed the SHS of the medical students by dividing AED the participants into two groups by the median SHS 10000‑<20000 252 (49.9) 33.4±14.0 score of 31, high SHS score group (SHS score ≥31), AED and low SHS score group (SHS <31). About half 20000> AED 79 (15.6) 31.7±14.2 of the respondents (52.5%) reported higher SHS Nationality UAE national 24 (4.8) 39.0±16.1 0.05 score and (47.5%) reported lower score. A similar Non UAE national 481 (95.2) 33.1±14.2 finding was reported among Chinese students where Health insurance prevalence rate of SHS was 55.9%.[12] Previous studies Yes 262 (51.9) 33.4±14.4 0.849 No 243 (48.1) 33.2±14.3 have likewise obtained results consistent with this Physical activity/ view.[13,14] The present study examined a variety of week factors associated with SHS among medical students. <1 h 106 (21.0) 31.7±12.5 0.198 Students aged between 15 and 19 exhibited higher 1‑2 h 46 (9.1) 32.7±13.4 3‑4 h 174 (34.5) 32.6±14.5 SHS score than those aged between 20 and 24 and ≥ 5 h 179 (35.4) 35.1±15.4 ≥25 years old (P = 0.040), (P = 0.013), respectively. Current smoking Moreover, SHS score decreased as the students’ class Yes 54 (10.7) 34.3±15.8 0.607 No 451 (89.3) 33.2±14.2 level in the university increased (P = 0.000). BMI Normal 302 (59.8) 33.3±14.0 0.165 The implications of this higher SHS score suggested (<25 kg/m2) that the studied students had a negative perception Overweight 109 (21.6) 35.2±15.9 about health complaints, had general weakness and 2 (25‑29.9 kg/m ) decline in vitality, physiological function and in the Obese (≥30 kg/m2) 94 (18.6) 33.3±13.5 capacity for adaptation. Therefore, early signs of SHS *P<0.05 is considered significant, SD: Standard deviation among medical students should be addressed hence an effective approach to the improvement of health, the the independent variables. There was an effect shown prevention of disease and the treatment of early stage of age on SHS (P = 0.002). Students aged between illness can be implemented in the medical universities. 15 and 19 were more likely to have SHS compared to those aged between 20 and 24 and ≥25 years old CONCLUSION (P = 0.040), (P = 0.013), respectively. There was an effect seen of study year on SHS (P = 0.000). First The results of the study emphasized the importance year students were more likely to have SHS compared of introducing a health promotion and counseling to final year students. However, gender, marital status, program that begin early in the medical colleges to screen early stage illness and adjust to different total monthly income, insurance coverage, physical learning environment during the first years of medical activity, and smoking were not associated with SHS. education.

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