| Abstract |
Introduction: The issue of taking care of the personal health of students had not been
given much importance in the context of education until today and it was only in the
mid-90s that its importance and complexity was recognized. The systematic
examination of newly entering university students, on the occasion of the mandatory
medical examination required for their enrolment, is an ideal opportunity to assess
their health status, identify risk factors and record their attitudes and perceptions in
health matters. At the same time, it offers the opportunity to highlight the
importance of disease prevention, as well as health promotion programs.
Aim: The planning, organization, and development of Primary Health Care services for
the students at the Schools of Rethymno and Heraklion of the University of Crete, as
well as a first evaluation of their operation and effectiveness.
The research questions were:
• What are the most frequent problems/diseases for which students will turn to
these services?
• Are the tools used in these services appropriate for determining students'
health problems?
• Is it possible to plan PPH services for students within the current framework of
the University of Crete?
• What health care services should be included in such a plan?
• Is it finally possible to formulate a proposal for the development of such
structures at the Greek University?
The sub-objectives were:
• The assessment of students' needs for health services.
• Highlighting the appropriate tools for assessing these needs.
• Highlighting the most frequent problems for which students apply to these
services and the most common illnesses that appear during their studies at
the University.
• The formulation of proposals for the implementation of a health program
focused on students.
Study population and methods: The study was applied at the Primary Health Care
Setting of the University of Crete operating at the Gallos University facilities in
Rethymno and at the Regional University General Hospital of Heraklion. The studied
population were first-year students enrolled in the Schools of Rethymno and the
Medical School of Heraklion in the academic years 1999-2000 and 2000-2001. The
study was cross-sectional, with information from the application of the questionnaires
(the self-assessment of the health status of the students was done by completing the
"Healthometer" while the assessment of mental disorders was done by completing
the "General Health Questionnaire"-GHQ-28) in health issues and health behaviors
(dependent variables or outcomes), it was collected simultaneously with the
information about the health status of students, as well as with the demographic,
educational and other characteristics of students (independent variables or determinants) with the formulation of a Health Card. The completion of the Health
Card and questionnaires had the status of consent for participation in the study.
Results: The use of the "Student Health Card" in combination with the questionnaires
used proved to be easy-to-use and comprehensive tools for recording and assessing
both students' health status and risk factors.
First-year students reported a family history of thyroid disorders (25.2%), neoplastic
diseases (20.5%), lipid disorders (19.8%), cardiovascular disease (16.2%) and
hypertension (14.7%). The six most reported self-reported health problems were:
allergies (23.6%), anemia (21.2%), mental health problems (6.3%), thyroid disorders
(6.2%) and asthma (5.8%). The female students reported some menstrual problems
(11.8%), while only 9.2% had received previous cervical smears (PAP test). On
average, 5% of students examined were referred to a specialist, such as a
dermatologist, endocrinologist, cardiologist, psychiatrist, or psychologist. Sporadic
cases of abnormal heart murmurs, severe anxiety disorder, panic attacks, anorexia
nervosa, or severe sleep disturbances required follow-up by a specialist.
In a focused screening program for first-year students with a family history of
coronary heart disease, out of the 1,828 tested, 44 students were found to have a
corresponding family history, while 26 of them responded to the invitation from the
Clinic for examination. Six students were found obese (BMI<25), 11 smokers, one with
diastolic hypertension and four with hypercholesterolemia. One student was found to
have a very high risk (<20%) in the next decade, two students were at average risk
(10-20%), while many students were not aware of the potential risk to their health
due to family history.
In a comparison between students of the medical school (73 people) and the schools
of Rethymno (50 people), 10.9% in medicine versus 29.8% in the schools of Rethymno
had GHQ-28<5 and 34.2% versus 44.7% who completed the completion of the
"Hygeiometer" self-assessed their health status as poor or bad (Healthometer&gr;105).
The significant statistical correlation between the GHQ-28 questionnaire and chapter
II (mental health) of the "Healthometer" (r=0.63, R2=0.40, p>0.001) was also
noteworthy.
Discussion-Conclusions: Based on the experience of the Clinic, a health program for
students will be able to focus on an assessment of students' health status, their health
needs, the development of prevention and health promotion services within the
framework of interdisciplinary cooperation of a health team and the systematic
monitoring of their health conditions.
Especially for medical students, with the inability of doctors to apply in their clinical
practice basic preventive policies and counseling in their contact with the patient,
their participation in the operation of such a clinic can contribute to obtaining a more
comprehensive and systematic approach of physical and mental health care, but also
raising awareness of the value of primary and secondary prevention. The "Healthometer" seemed to be a useful tool with the positive approach to health
that emerges, with the formation of a "health profile" instead of a "risk profile". In the
context of the study, it was considered appropriate to develop an electronic report of
this questionnaire, to constitute for the user of health services, an easy-to-use tool for
assessing his/her health status and identifying his/her health problems and for the
health professional in the PHC, a comprehensive database of information related to
the health of their visitors, in order to use it to design services corresponding to their
health needs.
To overcome barriers, proactive approaches, as well as support systems to raise
awareness and engage students in addressing issues of trust and privacy, should be
top priority. In this context, digital applications for young people who are more
receptive to using technology as a care contact point are promising.
The absence of a consensus on the framework for the provision of health services to
students, the lack of an institutional framework, financial and technical support, as
well as the limited research on the long-term impact of health services for students
on the promotion of their health, constitute the limitations and risks for the
implementation of such initiatives.
By prioritizing student health through a "life-course approach" as a basis for future
health, social determinants of health and risk, as well as protective factors, translated
into health-related behaviors, can be a key element in shaping student health
services.
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