Anthropometric Characteristics and Health Self-Assessment of Female University Students

Faculty of Medicine, University of Banja Luka, Institute of Physical Medicine and Rehabilitation “Dr Miroslav Zotović“, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina. Department of Physiology, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina. Faculty of Medicine, University of Banja Luka, Psychiatric Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina. Public Health Institute of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.


Introduction
Student population belongs to the young adult population and is in the post-adolescence period when a person has reached full maturity and development of all biological functions of the organism. 1 Moving from younger to older adolescence, significant changes affect the body and psychosocial well-being of young people. 2,3 Research records the occurrence of risky behavior of young people in the period of study and in a new and unfamiliar environment. [4][5][6][7] During this period, young people are considered "healthy" and they do not consider their own engagement in health promotion as their priority. The transition from high school to college education is a period of taking responsibility for oneself, one's health and social relationships. 4,8 During this period, young people often resort to different types of risky behaviors such as smoking, drinking, unprotected sex and poor eating habits. [9][10][11] Healthcare professionals care about the health of their patients, but they also play a role in health promotion in different parts of the population and especially in the student population. The most important stages of life for physical and mental health are childhood and adolescence. It is a period when young people develop autonomy, self-control, social interaction and learning and the abilities formed during this period directly affect their physical and mental health for the rest of their lives. Half of all mental health problems in adulthood occur during or Methods Results before adolescence. 2,12,13 Self-assessment of the existence of mental or physical changes or presence of certain symptoms, attempts to find out to what extent one is experiencing health problems or complaining of impaired physical functioning.
The aim of this study was to determine the anthropometric characteristics and to evaluate health of female students aged 19 to 22 at the University of Banja Luka. This observational analytical study included a survey and measurement of a sample of 408 female 1st-and 2nd-year students from various faculties of the University of Banja Luka. All students were healthy volunteers aged 19-22. Students with musculoskeletal inherited and acquired diseases, traumas and deformities of the body, acute and chronic diseases as well as with a special diet were not included. The research was approved by the Ethics Committee of the Faculty of Medicine of the University of Banja Luka (Approval Certificate No 18/4.56/18, dated 2 November 2018). All the participants were provided with a detailed oral and printed explanation of the research plan and programme and their written consents were obtained. In this research, the applicable regulations in compliance with the ethical principles of the Declaration of Helsinki were followed. For the purposes of the research, a short socio-demographic questionnaire was used. It provides personal information on the students' age, year of study, general health status. A standardised test was then used: the SF-36 self-report health questionnaire and the OMRON BF 511 digital scale for anthropometric measurements. SF-36 is a multifunctional health self-assessment questionnaire consisting of 36 questions (particles). [14][15][16] Individual responses to all of the particle items are scored according to pre-established empirical norms, given the diagnostic value of the examiner's specific response. The health change particle is displayed separately, by frequency distribution. The SF-36 measures the subjective sense of health across the eight different dimensions of health: physical functioning, restriction due to physical difficulties, physical pain, perception of general health, vitality, social functioning, restriction due to emotional distress, mental/ mental health. The SF-36 questionnaire is based on two general health concepts: physical and mental health, although the dimensions selected represent multiple health indicators, including: behavioural function and dysfunction, suffering and well-being, objective reports and subjective evaluations, and self-evaluation of favourable and unfavourable general health statuses.
OMRON BF 511 is a high-precision digital medical scale: after entering height, age and gender data, the subject stands barefoot without excess clothing on the scale measuring body mass and calculating the body mass index (BMI), body fat percentage, visceral fat (adipose tissue around the internal organs) and the percentage of skeletal muscle. Based on the measurement of the body bioimpedance, the body composition is calculated and recorded on the display. The accuracy of the device when measuring body mass from 40.0 to 150.0 kg is ± 1 %. The measurement results are categorised as follows: a) BMI is divided into 6 categories: malnutrition (BMI ≤ 18.5); ideal mass (18.5 to 24.9); overweight (BMI: 25-29.9); mild obesity (BMI: 30-34.9); severe obesity (BMI: 35-39.9); extreme obesity (BMI ≥ 40); b) Skeletal muscle and adipose tissue percentage of the total body mass, according to the known percentage of adult females aged 18-39, is divided into 4 categories: low percentage 0 to <24.3 %; normal percentage: 24.3 -30.3 %; high percentage: 30.4 -35.3 % and with very high percentage ≥ 35.4 % of total body mass. The measurement was always carried out by the same researcher, using the same instrument to reduce the erroneous measurements and the respondent verified that she had not consumed food and drink for at least 3 hours before the measurement, without intense physical activity for the last 12 hours, with a urinary bladder emptied.
For statistical data processing, descriptive and analytical statistics using SPSS 21.0 for Windows was utilised. Statistical significance was adopted at a probability level of p < 0.05.
The sample consisted of 408 female students aged 19-22 who attended the summer semester of the 1st or 2nd year of the University of Banja Luka (2018/2019 school year). The results of this research were divided into several segments.

C. Results of Sample Analysis by SF36 Scale
The Health Survey Questionnaire (SF-36) was used to assess the health status (Table 3 and Table  4). Descriptive analysis was calculated for eight   health scales (physical functioning), the role of physical restraint, physical pain, general health, vitality, social functioning, the role of emotional restriction and mental health). The reliability of the SF-36 scale was analysed with an alpha Cronbach coefficient whose values ranged from 0.81 to 0.94, which indicated a very good reliability and internal agreement for this sample, with the exception of items of social functioning and general health whose alpha Cronbach values were 0.65 and 0.69, respectively. Descriptive analysis of the SF-36 test (Table 3), which assesses 8 domains of health, shows that the lowest score has the Fatigue variable (mean = 50.10; standard deviation -SD = 17.83), which refers to the feeling of fatigue compared to the previous year and indicates that students are often not "full of energy and life." The highest score is perceived pain (mean = 77.57, SD = 20.89) and physical limitation (mean = 77.02, SD = 33.21).
The relationship between individual scores within the SF-36 questionnaire was investigated by using Spearman's rho non-parametric correlation. From Table 1 it can concluded that high statistical significance (p = 0.001) with positive cor-relation among the variables were found for vital energy (fatigue) and mental health (emotions), with coefficient of determination r 2 = 0.55 (55 %) and mental health and social functioning with r 2 = 0.36 (36 %). By using the Spearman nonparametric test (Table 4), the values of the correlation coefficient and the significance of the correlation were shown and the strength of the association between the subscales of the SF-36 questionnaire was determined. As expected, most of the correlations showed a statistical significance of different levels, in a positive direction, given the fact that all subtrees belong to the same type of test, intended to reveal different aspects of the physical and mental health of the subjects. According to the value of the correlation coefficient, the essential clinical significance was shown primarily by the positive correlations of Vital energy (SF-36 fatigue) and Mental health (SF-36 emotions) (ρ = 0.742; p < 0.01) as well as General mental health (SF-36 emotions) and Social functioning (SF-36 soc. funct.) (ρ = 0.595; p < 0.01), which are also mental health categories. The absence of significant correlations was reported for Physical functionality paired with Near vital energy, Mental health and Pain. In the realm of physical health, the associated sub-axes: physical functioning, physical limitation, physical pain, and general health perception are low positive correlations with high statistical significance for p<0.05, ex-

Discussion
This research was aimed to demonstrate how and to what extent the initial years of studying at the university affect the health of female students through the aspect of self-assessment of physical and mental health as a significant moment in the life of a young woman. By going to college, students face the challenge of changing their previous habits in order to cope with the academic workload and stress that their schooling carries. This often implies lack of time for rest and sleep, physical and recreational activities, but also changed health habits leading to malnutrition, excessive alcohol consumption, smoking and consumption of psychoactive substances, which is confirmed in the current study. Psychostimulants were used by 0.2 % of female students, hallucinogens by 0.2 %, sedatives by 0.7 %; while 35 % of students drank alcohol periodically, tobacco was consumed by 15.9 % regularly, while 7.1 % used marijuana. In the Netherlands, the prevalence of smokers has been shown to be relatively low, only 6 %, but with 46 % of students consuming alcohol and over 6 % of students using stimulants, tranquilisers or sleeping remedies in the last 30 days. 17 Among medical students in Germany there were 21 % smokers, with 34 % of students confirming the use of psychoactive substances. 18 Research in Poland has shown that sixth-year medical students have a very cursory knowledge of the harmful health effects of alcohol consumption and smoking, with 26 % of female students being smokers. 19 A study conducted among students in Toulouse, France, also confirmed that approximately the same percentage of smokers among students in this European country was around 23 %. More than half of students use some of psychoactive substances. 20 A study in Istanbul among students of the Faculty of Physical Activity and Sports showed that 25 % were smokers and that at the age of 18 most girls started smoking. 21 The results of the descriptive analysis of demographic parameters provided data on the anthropological characteristics of female students of the first two years of the University of Banja Luka. These are young persons, 20.5 ± 0.7 years old, averaged 168.65 cm ± 6.01 in height, 63.09 ± 9.9 kg in body weight, corresponding to BMI 22.1 ± 3.2 kg/m 2 and thus characterised as persons with an ideal BMI, which is a common result in studies by authors from neighbouring countries. [22][23][24][25][26][27][28] The University of Banja Luka students are higher than their female counterparts in Canada, 29 Greece, 30,31 and Croatia, 23 while female students from Brazil are higher than the students from the University of Banja Luka. 33 According to the measurements performed in this study, the proportion of adipose tissue was 31.80 ± 6.47 %, ranging from 17. The results of the study of anthropological characteristics of the students showed the ideal values of the total BMI. A lower percentage of muscle mass indicates a possible lack of physical fitness. The results of the self-assessment of health show that this population of young women has higher values of physical health compared to mental health, which may be a reflection of stress and a degree of psychological distress during studies.

Conflict of interest
None. None.
score on this MH scale indicates the presence of psychological pain and significant limitations in social functioning, resulting in stress and a degree of psychological distress. A high score on the MH scale is more appropriate for the student population as it relates to a positive emotional state and complete social activities. Achieving a high score on this scale is associated with frequent feelings of happiness and life satisfaction and a person perceives their health as excellent. The "vitality" subscale, which is one of the sub-categories of SF-36, was the lowest in all subsamples, which may be a sign of population fatigue. 34