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  • Published: 10 March 2020

Health-related quality of life and associated factors among patients with diabetes mellitus at the University of Gondar referral hospital

  • Andualem Yalew Aschalew 1 ,
  • Mezgebu Yitayal 1 &
  • Amare Minyihun 1  

Health and Quality of Life Outcomes volume  18 , Article number:  62 ( 2020 ) Cite this article

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Diabetes mellitus, which has a wide range of effects on the physical, social and psychological aspects of the well-being of a person, is a common and challenging chronic disease that causes a significant rate of morbidity and mortality. However, studies in our country, by and large, focused on the impact of the disease in terms of mortality and morbidity alone. Therefore, the objective of this study was to assess the health-related quality of life (HRQOL) and associated factors of diabetic patients at the University of Gondar referral hospital, Ethiopia.

A facility-based cross-sectional study was conducted at the University of Gondar referral hospital from April to May 2017. A generic World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to measure the HRQOL. The data were analyzed by Stata version 12. Multiple Linear Regression analysis with P -value 0.05 was used to measure the degree of association between HRQOL and independent variables.

A total of 408 patients with Diabetes Mellitus were included in the study. The HRQOL scores for physical, psychological, social and environmental domains were 50.9, 54.5, 55.8 and 47.3, respectively. Diabetes-related complications had a significant association with all except the psychological domain. Higher HRQOL was associated with exercising, following the recommended diet, foot care, sensible drinking and the absence of co-morbidities. However, old age, unemployment and being single and widower had a significant association with lower HRQOL.

The environmental and physical domains of HRQOL scores were the lowest compared to the social and psychological domains. Old age and living in rural area had a significant association with a lower HRQOL, whereas the absence of diabetes-related complications, exercising, general diet and foot care had a significant association with better HRQOL of patients. Therefore, strong advice on the recommended lifestyle is important, and old patients and rural dwellers should get due attention. In addition, the prevention of diabetes-related complications is important to improve the patient HRQOL which is an important outcome measurement from the patient’s perspective related to the impact of the disease. Therefore, including HRQOL assessment as part of routine management is necessary.

Diabetes mellitus (DM) is one of the chronic diseases that affect both developed and developing countries. The International Diabetics Federation (IDF) reported that in 2015, the disease affected 415 million people worldwide and will rise to 642 million in 2040. An estimated 14.2 million adults aged 20–79 suffer from diabetes in the Sub-saharan Africa. Ethiopia is one of the most populous countries in this region and has the highest number (1.3 million) of people with diabetes. The prevalence of DM, which is one of the four major chronic diseases in the country, is about 3.8% [ 1 , 2 ].

The impact of diabetes on a patient can be measured by traditional methods, like biochemical, morbidity and mortality although attention has recently been given to measuring health-related quality of life (HRQOL). HRQOL is important to assess the impact of the disease from the patient’s perspective [ 3 , 4 , 5 , 6 , 7 , 8 ]. Hence, HRQOL can be defined as “the subjective assessment of the impact of disease and its treatment across the physical, psychological and social domains of functioning and well-being” [ 9 ].

Diabetic patients feel about their blood glucose level and worry about the complications they might be developing or actually exist. Moreover, the never-ending care and lifestyle adjustments, like dietary change and exercise have an impact on patients’ HRQOL (physical, emotional and social well-being) [ 10 , 11 ]. Different studies have shown that the presence of diabetes has an impact on HRQOL and reduces the physical, psychological, environmental and social domains of health [ 12 , 13 , 14 , 15 ]. People with diabetes experience significant impairment in their HRQOL compared to non-diabetes people [ 16 , 17 , 18 ].

Health professionals can identify the physiological derangement and degree of deteriorations due to diabetes. Nevertheless, an individual patient’s health perceptions and well-being are not directly proportional to symptoms and functional limitations which in turn are not directly proportional to physiological and anatomic abnormalities. Therefore, the effects flowing from biological abnormalities to HRQOL are mediated and modified by psychological, social and cultural factors [ 19 ]. However, studies in our country, including those in the current study area focus on the impact of diabetes in terms of morbidity and mortality alone [ 20 , 21 , 22 ]. As far as we know, there has been no study on the psychosocial impact of diabetes in the study area. Therefore, this study aimed to determine the HRQOL of diabetic patients and to identify factors associated with it.

Study design and setting

An institution-based cross-sectional study was conducted at the University of Gondar referral hospital chronic illness follow-up outpatient clinic from April to May 2017 to assess HRQOL. The hospital, located in North Gondar zone, is one of the tertiary level health care facilities in Ethiopia. It has an outpatient department for chronic illness follow up and diabetes treatment provided 2 days a week to an average of 900 diabetic patients per month. It also has inpatient facilities where medical care is provided throughout the week.

Study population and sampling procedures

The population was all adult diabetic patients in the chronic illness follow up clinic during the study. All adult diabetic patients on follow-up for at least 6 months were included, whereas individuals with gestational diabetes and patients who were unable to communicate were excluded. The sample size was determined using a power approach (double population formula) from a previous study [ 23 ] by considering type I error of 0.05, type II error of 0.10, confidence interval 95%, standard deviation (SD) one 17.22, SD two 13.79, mean difference 5.2 and non-response 10%. Therefore, the final sample size of the study was 416. All diabetic patients who came to the University of Gondar referral hospital for follow ups were recruited consecutively until the minimum required sample size was reached.

Data collection tools and procedures

The World Health Organization quality of life (WHOQOL-BREF) the short version of the WHOQOL-100 SCALE was used to collect data. The questionnaire which contains 26 items was developed with 15 international field centers to obtain an assessment tool applicable cross-culturally [ 24 ]. The WHOQOL-BREF contains four specific domains (physical, psychological, social and environmental). The questionnaire was first adopted in the English language and translated to Amharic and back-translated to English to maintain its consistency. Factors relating to socio-demographics (age, sex, marital status, educational level, occupation, residence, ethnicity, religion and wealth index), clinical data (duration of diabetes, type of diabetes, diabetes-related complications, co-morbidities: any chronic diseases other than diabetes mellitus, body mass index, type of treatment and fasting blood glucose) and Lifestyle (smoking, physical exercise, diet, foot care and alcohol consumption) were included in the questionnaire.

Data on patient socio-demographics, lifestyle, HRQOL and some clinical data were collected by a trained interviewer, while some clinical data (co-morbidities, diabetes-related complications, diabetes type and fasting blood sugar) were taken from patients’ medical record cards.

Operational definitions

  • Health-related quality of life

The instrument used was the WHOQOL-BREF of the WHOQOL-100 scale. This questionnaire contains 26 items computed into four specific domains: physical, psychological, social and environmental. The mean score on items within each domain was used to calculate the domains score. Higher scores denoted a higher HRQOL, and lower scores indicated lower HRQOL [ 24 ].

Body mass index

BMI was calculated by dividing weight into height squared and divided into four categories based on WHO classification [ 25 ]: underweight = < 18.5, normal weight = 18.5–24.9, overweight = 25–29.9 and obese = ≥30.

Alcohol consumption was assessed by using Fast alcohol screening test and split into two categories [ 26 ]: Non-hazardous drinker = < 3 and Hazardous drinker = ≥ 3.

Summary diabetes self-care activity (SDSCA)

This tool assessed the number of days per week on a scale of 0–7 on which the patient performed the recommended self-care activities [ 27 ].

General diet = Mean number of days the patient follows the recommended diet plan.

Specific diet = Mean number of days the patient eats fruits and fatty foods.

Exercise = Mean number of days the patient performs a minimum of 30 min activity.

Foot care = Mean number of days the patient takes care of their feet and check the inner part of their shoes.

Smoking status = (1 = smoker 2 = non-smoker).

Data analysis

The collected data were checked for completeness. Then, codes were given to each question and entered into Epi-Info Version 7 Software. Further analysis was done with Stata version 12. Where an item was missing, the mean of other items in the domain was substituted. But when more than two items were missing from the domain, the domain score was not calculated with the exception of domain 3, where the domain should be calculated if only one item is missing. Negatively framed questions (items 3, 4 and 26) were transformed into positively framed ones. Cronbach alpha was used to check the reliability of the items and domains. Raw and transformed scores were considered for the outcome variables. Summary statistics were done for the outcome and independent variables. Model assumptions (normality, equal variance, multicollinearity and linearity) were checked. Simple linear regression analysis was done to identify factors associated with each domain of HRQOL independently at a P -value < 0.2. Variables that were significant at a p -value of < 0.2 were selected for the final multiple linear regression model. In the multiple linear regression analysis, variables with P -values of < 0.05 were considered statistically significant.

Socio-demographic and economic characteristics of the study participants

A total of 416 diabetic patients participated in the study. Eight (1.92%) questionnaires were excluded from the analysis because they were incomplete. Of the participants, 54.7% were male, and 33.7% were unable to read and write. Their mean age (SD) was 47.48 ± 14.9 years (Table  1 ).

Clinical and lifestyle characteristics of study participants

Approximately, 56.6% of the participants were type 2 diabetes; 28.92% had co-morbidities, and 21.57% developed a diabetes-related complication (Table  2 ).

In this study, 41.91% of the participants rated their quality of life as good, and 18.14% were satisfied with their current health status (Table  3 ).

The four domains had good internal reliability with Cronbach Alpha: physical α = 0.77, psychological α = 0.69, social α = 0.73 and environmental α = 0.71. out of the 4 domains, the environmental domain HRQOL had the lowest mean score. In contrast, the social domain of HRQOL had the highest score (Table 4 ).

Factors associated with health-related quality of life

In this study, some socio-demographic, clinical and lifestyle variables were statistically significant determinants of each domain of HRQOL at a p -value of 0.05.

Age had a significant association (B = −.13, 95% CI = − 2.5, − 0.1), (B = −.16, 95% CI = −.30, −.01) and (B = −.20, 95% CI = −.34, −.05) with physical, psychological and social domains, respectively. Being single (B = − 6.70, 95% CI = − 12.43, −.97) and being widowed (B = − 6.64, 95% CI = − 12.6, -.613) had a significan association with the social and psychological domains, respectively. The environmental domain was significantly associated with secondary and above education level (B = 3.87, 95% CI = .14, 7.60), residence (B = − 3.88, 95% CI = − 7.72, −.04) and foot care (B = 1.12, 95% CI = .55, 1.70). Co-morbidity and occupation had a significant associate with physical domaim (B = 5.55, 95% CI = 2.55, 8.55). Diabetes-related complication statisticaly associated (B = 4.5, 95% CI = 1.17, 7.83), (B = 7.69, 95% CI = 3.18, 12.2) and (B = 3.88, 95% CI = .99, 6.77) with physical, social and environmental domains, respectively. Exercise was associated (B = 0.89, 95% CI = .08, 1.69) and (B = 1.28, 95% CI = .28, 2.29) with the physical and psychlogical domains, respectively. General diet had also a significant association (B = 0.84, 95% CI = 07, 1.61), (B = 1.14, 95% CI = .08, 2.20) and (B = 1.41, 95% CI = .71, 2.10) with the physical, psychlogical and environmental domains, respectively. Being hazardous drinker was statistically associate (B = 8.14, 95% CI = 4.08, 12.2) with the psychologicla domain (Table  5 ).

This study was done on patients with DM at the University of Gondar referral hospital. The results revealed that diabetes had an impact on HRQOL for diabetic patients in different domains. The maximum and minimum scores were related to social and environmental domains, respectively. Age, general diet and diabetes-related complications had a significant association with at least three domains of HRQOL.

The study found that patients had the lowest score (47.31 ± 2.51 out of 100) in the environmental domain compared to the three domains, whereas the social domain had the highest score (55.88 ± 17.63). The psychological and physical domains were also approximately average out of hundred. Although there was no cut-off point for WHOQOL-BREF to categorize HRQOL as high or low, the finding showed the score of each domain was approximately average and diabetes had an impact on patients’ health and well-being. Lifestyle modifications of diabetes treatment such, as diet (eating carefully), exercising, monitoring blood glucose, worry about complications associated with diabetes and the dependence of life (daily activity) on medication are some of the explanations for the reduction of HRQOL. These might cause negative feelings, such as depression, affect social interactions and recreational activities. Different studies have also shown that diabetes affects patient’s HRQOL compared to healthy individuals [ 28 , 29 ]. The result is in line with that of a study conducted in Kenya [ 12 ] in terms of the sequence of domains affected by diabetes.

In terms of all domains, the HRQOL score of this study is higher than that of Palestine, Gaza, which used similar tools [ 17 ]. The Possible explanation might be differences in psycho-social, cultural, economic, and environmental conditions. For instance, the participants of the present study lived in a stable and peaceful environment and had relatively their own living facility, access to the health facilities and other infrastructures compared to refugee patients in Gaza who depended on refugee camp supplies. Studies in Benin, Nigeria and Uganda [ 28 , 30 ] also have lower scores than the current study. A possible explanation might be differences in measurement tools.

A study in Iran with WHOQOL-BREF [ 23 ] shows the four domains of HRQOL are higher than those of the current study. A possible explanation might be differences in economic status, satisfaction with the infrastructure and health care service and clinical characteristics of patients. Moreover, studies from India also have higher scores than the current study [ 31 , 32 , 33 ].

Age had a significant association with all domains of HRQOL except the environmental domain. This is in line with those of studies in Kenya and Singapore [ 12 , 34 ]. This can be explained by the fact that age is related to several changes in the body and increases the risk of developing co-morbid diseases and further reduces individual well-being. The American Diabetes Association [ 35 ] also shows that the aging process leads to a degeneration of muscles, ligaments, bones, and joints and that diabetes may exacerbate the problem. Moreover, occupation and education had a significant association with the physical and environmental domains of HRQOL, respectively. Employed, farmer and retired had a higher score on the physical domain compared to unemployed. Patients with above secondary education level had a higher score on the environmental domain than those who were unable to read and write [ 13 , 30 , 36 ]. Education is an essential factor in understanding self-care management and perception of self-worth. The patients with a high educational level can easily read and understand the effects of diabetes and this might lead to better awareness about the disease such as complications. Furthermore, it contributes to a high rate of adherence to self-care management such as diet.

This study showed that patients without co-morbidities had a better score in the physical domains of HRQOL than patients with co-morbidities. This is supported by studies in Nigeria and Singapore [ 34 , 37 ]. Moreover, diabetic patients without diabetes-related complications had a better HRQOL in all domains except the psychological domain. This is in line with the findings of in Palestine and Singapore [ 17 , 34 ] that patients with diabetes-related complications had a lower HRQOL.

Marital status had a significant association with the social domain. Those who were single were more likely to have a lower HRQOL compared to the married ones. This is supported by a study in Nigeria, which reported that singles had lower odds of HRQOL than couples [ 38 ]. In addition, compared to married women widowed women had a lower score of the psychological domain of HRQOL. This might be because the probability of getting social or relative support is better for those who live in marital bonds.

Out of the lifestyle factors, exercise had a significant association with physical and psychological domains. Following a recommended general diet also had a significant association with all domains except the social domain. An interventional study in Sandiego, California [ 39 ], showed that exercising and adhering to the recommended diet had a positive impact on the HRQOL of patients. Studies in Nigeria and Canada [ 36 , 37 ] are also in line with this finding. As the number of days of foot care increased the psychological and environmental domains of HRQOL also improved. A study done in Uganda [ 30 ] revealed that patients with foot ulcers had a low HRQOL. Hence, foot care was a good measure to prevent foot ulcer and improve HRQOL by increasing patients’ sense of physical safety, enabling them to participate in recreation, and avoiding long-treatment, hospitalization and amputation. Finally, sensible drinkers had a better HRQOL of the psychological domain compared to the hazardous drinkers. Studies showed that moderate to heavy drinkers had a lower HRQOL (mental health) than nondrinkers or occasionally drinkers [ 40 , 41 ]. Alcohol consumption can impair an individual’s cognitive and altered consciousness. Studies revealed that alcohol consumption (excessive) impaired glycemic control which leads to worrying about the level of glucose, depression, complications and reduces satisfaction with their health status [ 42 ].

Compared to urban residents rural dwellers had a lower score in the environmental domain of HRQOL. Although evidence that directly compares residence with HRQOL is limited, there are clear differences with respect to access to health services, information, education and living standards between rural and urban settings. All these might contribute to the low score of the environmental domain of HRQOL. Studies, from the normal population, showed that subjects who live in the urban areas had a higher HRQOL than subjects who live in rural areas [ 43 , 44 ].

Limitation of the study

This was a cross-sectional study which was able only to detect associations, but not causalities. In addition, some important variables, like lipid profile and HgA1c were not included. As the study was conducted in one setting, findings might not be representative of the diabetic patients in other settings.

Diabetes has an impact on the patient’s HRQOL. The diabetic patients have often expressed their dissatisfaction with their health status and rated their quality of life as “poor” showed that the disease had a marked impact on their HRQOL. Environmental and physical domains of HRQOL were the lowest compared to the social and physical domains. Old age and living in rural areas had a significant association with low HRQOL, whereas the absence of diabetes-related complications, exercise, general diet and foot care were significantly associated with high HRQOL. Therefore, providing strong advice on the recommended lifestyle is important, and old age and rural dweller patients should get emphasis. In this respect, the prevention of diabetes-related complications is important to improve patient’s HRQOL which is an important outcome measurement from the patient’s perspective relating to the impact of the disease. Therefore, including HRQOL assessment as part of routine management is necessary. Since HRQOL is multidimensional, establishment of a multidisciplinary team of physicians, nutritionists, fitness coaches and social workers is important that works to educate and empower patients. Finally, a further longitudinal study will be needed for understanding the associations of factors influencing HRQOL.

Availability of data and materials

The datasets supporting the conclusions of this article are available upon request to the corresponding author. Due to data protection restrictions and participant confidentiality, we do not make participants’ data publicly available.


Confidence interval

Diabetes Mellitus

Diabetes-related complication

International Diabetes Federation

Standard deviation

Summary of diabetes self-care activities

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We are very thankful to the University of Gondar for the approval of the ethical issue and its technical and financial support. We forward our appreciation to the hospital managers for allowing us to conduct this research and their cooperation. Finally, we would like to thanks study participants for their volunteer participation and also data collectors and supervisors for their genuineness and quality of work during data collection.

This is part of a master thesis funded by the University of Gondar. The preliminary findings of this study were presented at the Institute of Public Health, University of Gondar. After incorporating the comments, the authors have prepared this manuscript for publication at BMC Health and Quality of Life Outcomes. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

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Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Andualem Yalew Aschalew, Mezgebu Yitayal & Amare Minyihun

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AY designed the study, developed data collection tools, performed the analysis and interpretation of data and drafted the paper. MY and AM participated in the development of the study proposal, analysis and interpretation, revised drafts of the paper, revised the manuscript. All authors read and approved the final manuscript.

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AY is a lecturer of Health Economics in the Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

MY is an Associate Professor of Health Service Management and Health Economics in the Department of Health Systems and Policy, Institute of Public Health; and a member of a research team in the Dabat Health and Demographic Surveillance System, University of Gondar, Gondar, Ethiopia.

AM is a Lecturer of Health Economics in the Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

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Correspondence to Andualem Yalew Aschalew .

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The study was conducted after ethical approval was obtained from the Ethical Review Board of the Institute of Public Health, College of Medicine and Health Science, University of Gondar (Ref. No.: IPH/2429/2017). Permission letters were obtained from the University of Gondar Referral Hospital. All study participants were oriented on the objectives and purpose of the study prior to study participation. Confidentiality and anonymity were explained. Patients at health facilities and sick individuals were informed that participation had no impact on the provision of their health care. Study team members safeguarded the confidentiality and anonymity of study participants throughout the entire study. Interviews were conducted in quiet areas, enclosed whenever possible, to ensure participant privacy. In order to protect the identities of the study participants, each participant was given a unique identification number (ID). All forms and data related to the study were stored in a locked room in a secured area, with controlled access available only to the investigator and supervisors. Participation in the study was voluntary and individuals were free to withdraw or stop the interview at any time.

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Aschalew, A.Y., Yitayal, M. & Minyihun, A. Health-related quality of life and associated factors among patients with diabetes mellitus at the University of Gondar referral hospital. Health Qual Life Outcomes 18 , 62 (2020). https://doi.org/10.1186/s12955-020-01311-5

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DOI : https://doi.org/10.1186/s12955-020-01311-5

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Health and Quality of Life Outcomes

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thesis on quality of life

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PhD Thesis: A life course study of quality of life at older ages in a French occupational cohort

Profile image of Loretta G Platts

Background and aims. This thesis took a life course approach to examining inequalities in quality of life in early old age using the French occupational cohort GAZEL. The cohort combines company administrative records with information from annual questionnaires for 20 625 electricity and gas industry employees. The thesis aimed to examine whether current circumstances, retirement routes, mid-life working conditions or occupational grade were associated with subjective quality of life, measured with CASP-19, in retired participants. Results. Cross-sectional and change analyses using multiple regression demonstrated that social support, financial adequacy and, above all, mental and physical health were strongly associated with quality of life. There was a graded relationship between occupational grade in mid-life and quality of life following labour market exit, a relationship which was largely accounted for by health and financial circumstances in retirement. After adjusting for occupational grade and social class, exposures to physical hazards and ergonomic strain were associated with lower quality of life following retirement; accumulated exposures to carcinogens were not. Pathways from working conditions to poorer quality of life via physical and mental health accounted for the associations between earlier strenuous and dangerous working conditions and quality of life following retirement. Retiring tended to improve subjective quality of life, particularly if it was from difficult psychosocial working conditions. Retiring in ill health was associated with worse quality of life; this retirement route was more likely for individuals who had poor working conditions. Continuing professional activities after retirement was associated with better quality of life, a retirement route more likely for individuals working in higher grades. Conclusions. The thesis demonstrated small but persistent life course influences of employment characteristics upon quality of life which appeared to be mediated via current determinants of quality of life.

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Martin Lakomý

This paper examines the effect of prolonged working careers on subjective quality of life (QoL) in four European regions. The paper tests a basic assumption of the role accumulation theory and the active ageing approach that additional roles, including prolonged working careers, are beneficial for the quality of life of older people. The propensity score matching method was used on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for four European regions with distinctive economic, institutional, and cultural contexts connected to paid work. The context-sensitive effects of prolonged labour force participation on QoL as a whole, control, and pleasure are positive in regions in which financial need serves as a more important motivation to work than nonmaterial need. In contrast, the effects on QoL as a whole and autonomy are negative in wealthier and more developed European regions. The paper concludes that the main motivation for prolonged working careers seems to be to avoid deteriorating living standards; satisfactory retirement conditions should thus be an aim complementary to incentives for those who are willing and able to work longer.

thesis on quality of life

European Journal of Public Health

Giorgio Di Gessa , Debora Price

Background: Employment histories influence health. However, most studies have so far investigated cross-sectional associations between employment histories and health, failing to recognize health as a dynamic process in later life. Methods: We use Waves 3-8 of the English Longitudinal Study of Ageing, including retrospective information on respondents' employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression. Results: Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10-year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women. Conclusion: Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

Aging & Mental Health

Loretta G Platts

Objective: To investigate variations in quality of life at older ages, we take a life course perspective to analyse long-term effects of physical working conditions upon quality of life after retirement. In doing so, we study to what extent these associations are explained by individuals’ health at older ages. Method: We use administrative data and self-administered questionnaire responses from the French GAZEL cohort. Quality of life was assessed with CASP-19 in 2009 and related to three types of physical working conditions during previous working life: (1) ergonomic strain, (2) physical danger and (3) exposures to chemicals. Health was assessed in 2007 with the SF-36 Health Survey. Multiple regressions were calculated in retired men only, controlling for important confounders including social position. Results: In contrast to men, few women were exposed to strenuous and dangerous working conditions in this cohort and were not included in subsequent analyses. Negative effects on retired men's quality of life were found for the physical occupational exposures of ergonomic strain and physical danger, but not for chemical exposures. Effects were attenuated after the introduction of physical and mental health to the models, indicating an indirect effect of physical working conditions upon quality of life via health. Conclusion: Adverse physical working conditions have long-term consequences for health and quality of life at older ages. Improvements to physical working conditions may improve individuals’ quality of life over the long term.

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Pingo Kåreholt

victor marshall

The relationship between employment and retirement is changing dramatically. In contrast to an earlier pattern of relatively stable career employment leading to retirement around age 65, increasing numbers of men and women are leaving their major employment situation earlier. The process of retirement therefore takes on new meaning and duration. The segment of a person&#39;s life between stable career employment and permanent retirement at pensionable age can be quite disruptive, involving difficult job searches, employment at lower levels than before, lower wages and repeated job displacement. There is virtually no research about the effects of life course instability in mid- to late-life on health, but limited research on instability early in the working life shows that instability leads to increased mortality. The possibility that labour force instability later in life has adverse health consequences is great and merits further investigation.

Christina Matz-costa

shifts as well as changes in the lives of older workers. Economic conditions, occupation-specific labor force shortages, and new attitudes about aging and work have affected older workers’ decisions about continued labor force participation. There have also been changes in the experience of older workers themselves that affect their decisions about work and retirement. The improved health status of older adults has increased life expectancy of both men and women.3 As a result, a greater percentage of older workers are physically able to continue to work. The assessments that older workers make about the adequacy of their financial resources affects their decisions as well. In fact, a minority of Baby Boomers (approximately one-quarter) report that they are very confident that they will have enough money to live comfortably in retirement.4 In summary, older people are increasingly finding that they either want to work and/or they have work.

Occupational and environmental medicine

Kristina Alexanderson

Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study. Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up. Multistate life table models showed that job...

Annals of Economics and Statistics

Thomas Barnay


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Essays on the Quality of Life

  • Alex C. Michalos

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Part of the book series: Social Indicators Research Series (SINS, volume 19)

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Table of contents (20 chapters)

Front matter, reflections on twenty-five years of quality-of-life research, combining social, economic and environmental indicators to measure sustainable human well-being, evaluation of equality policies for the status of women in canada, militarism and the quality of life, migration and the quality of life: a review essay, job satisfaction, marital satisfaction and the quality of life: a review and a preview, discrepancies between perceived income needs and actual incomes, optimism in thirty countries over a decade, health and the quality of life.

  • Bruno D. Zumbo, Anita Hubley

Health and other Aspects of the Quality of Life of Older People

  • Anita M. Hubley, Bruno D. Zumbo, Dawn Hemingway

Healthy Days, Health Satisfaction and Satisfaction with the Overall Quality of Life

  • Bruno D. Zumbo

Leisure Activities, Health and the Quality of Life

Social indicators research and health-related quality of life research, public services and the quality of life, criminal victimization and the quality of life, policing services and the quality of life, feminism and the quality of life.

  • Deborah C. Poff

Ethnicity, Modern Prejudice and the Quality of Life

The impact of trust on business, international security and the quality of life.

  • environment
  • quality of life
  • quality of life research
  • social indicators

Book Title : Essays on the Quality of Life

Authors : Alex C. Michalos

Series Title : Social Indicators Research Series

DOI : https://doi.org/10.1007/978-94-017-0389-5

Publisher : Springer Dordrecht

eBook Packages : Springer Book Archive

Copyright Information : Springer Science+Business Media Dordrecht 2003

Hardcover ISBN : 978-1-4020-1342-3 Published: 31 July 2003

Softcover ISBN : 978-90-481-6304-5 Published: 15 December 2010

eBook ISBN : 978-94-017-0389-5 Published: 17 April 2013

Series ISSN : 1387-6570

Series E-ISSN : 2215-0099

Edition Number : 1

Number of Pages : XII, 492

Topics : Sociology, general , Quality of Life Research , Public Health , Economic Policy , Quality of Life Research

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Editorial: Nutrition and Health-Related Quality of Life: Is It an Ignored Outcome?

Leila itani.

1 Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon

Rosa Sammarco

2 Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy

Marwan El Ghoch

The concept of quality of life (QoL) represents the well-being of people living in a certain society, broadly including physical health, family, education, employment, wealth, religious beliefs, finance and the environment ( 1 ). In the last three decades, a new dimension of QoL has increased in interest and has become known as the “health-related quality of life” (HRQoL) ( 2 ), which assesses how the individual's well-being may be affected over time, either as a result of a disease, disability or disorder. In fact, the research which focused on HRQoL is extremely important, since its assessment helps monitor progress in terms of achieving the nation's health objectives ( 3 ), through its influence on current and future treatments, and health protocols across a wide spectrum of diseases ( 4 ).

On the other hand, nutrition is a vital process through which human beings retrieve energy needed for reproduction, growth and development, as well as health maintenance ( 5 ). In fact, over- and malnutrition are both associated with medical diseases ( 6 ) and psychological disorders ( 7 ). It must be remembered that the management of many of these conditions is the result of adequate nutrition ( 8 – 10 ). However, and despite this fact, there is a lack of knowledge relating to the link between nutrition and HRQoL ( 6 ), consequently, our Research Topic is entitled: “ Nutrition and Health-Related Quality of Life: Is it an Ignored Outcome? ” so as to attract investigators from different backgrounds, interested in both areas, namely, human nutrition and HRQoL, in order to clarify the link between the two and the nature of their interaction.

We received 17 submissions; six of these were declined following an initial editorial assessment. Eleven papers were accepted after one or more rounds of peer revision as follows: 1 clinical trial, 7 original research documents, 1 systematic review, 1 data report and 1 commentary, sourced from 11 different countries.

Di Iorio et al. reported on the beneficial effect of 30-min monthly sessions over 12 months in patients with type 2 diabetes mellitus, using an “Individualized Nutritional Therapy,” based on counting carbohydrates, which improved the patients' state of health, preventing cardiovascular risk and exponentially impacting their QoL.

Yue et al. , in a pilot study, tested the feasibility and impact of a nutritional support strategy on the clinical outcomes of severe and critical patients with SARS-CoV-2 pneumonia, based on underfeeding, which restricted non-protein calories but preserved protein intake. Following the same theme, De Pipaòn et al. argued in a commentary that consumer reports of “Keto Flu” were associated with a ketogenic diet.

Liu et al. conducted a large, multicentre, prospective study, composed of 9,996 participants, aged 65 years and older. Their nutritional status and HRQoL were measured using the Mini Nutritional Assessment—Short Form (MNA-SF) and the EuroQoL, respectively. The authors found that higher MNA-SF scores were related to an improved HRQoL.

Chen et al. identified an inflammatory-nutritional marker in a study composed of patients with acute kidney injury (AKI), that could predict mortality in this population; a higher PCT to Albumin ratio was strongly associated with higher mortality in sepsis-induced AKI patients.

Gathercole et al. compared the impact of the two dietary interventions modification of dietary protein intake over a period of 10 weeks on the host fecal proteome in elderly males, who either met the minimum dietary protein recommendations (RDA) or consumed twice the recommended dietary allowance (2RDA).

Lachaud et al. examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years, and the association of these trajectories with food security. Authors in this study reported that individuals with substance use disorder, who never moved into stable accommodation, had the lowest food security status.

Wu et al. investigated the associations of diet quality, physical activity (PA), sedentary behaviors (SB) and HRQoL among children with mental health disorders. They found that health promotion programs, which focused on promoting a high-quality diet, increased PA, a better HRQoL and reduced SB among children, could contribute to improving mental health.

Gao et al. evaluated the effect of home enteral nutrition on nutritional status, body composition (BC), HRQoL and other clinical outcomes in malnourished patients with intestinal failure. It was found that home enteral nutrition improves nutritional status, BC and HRQoL.

Wang et al. conducted a systematic review of controlled trials (RCTs) to explore the efficacy of a low-FODMAP diet (LFD) with regard to alleviating the symptoms of irritable bowel syndrome (IBS). They found that an LFD is effective in reducing the global symptoms and improving the bowel habits of adult patients with IBS.

Leão et al. explored the association between nutritional status and functional status among older adults receiving assistance from the in-home nursing care service. The primary finding of this study was that better functional status is directly associated with good nutritional status.

All the studies included in this Research Topic either directly or indirectly explored the link between nutrition and HRQoL, based upon which we can identify two types of interaction: ( 1 ) bi-direction interaction: in other words, a good nutritional status leads to a better HRQoL and vice-versa or ( 2 ) synchronic interaction: the two interact with one other to impact another outcome, i.e., an adequate nutritional status plus adoption of a good QoL may improve a medical disease or a psychological disorder. Clearly, future research is still needed to replicate these findings and to consolidate them.

In conclusion, we are grateful to “Frontiers in Nutrition” for giving us the opportunity to serve as editors for this Research Topic; it has been such a challenging and motivating experience from which we have learned a great deal and which we intend to continue. Secondly, we would like to thank our valuable authors for sharing their research in this collection, which we believe will have relevance for the readership in their clinical practice. Last but not least, we wish to thank our reviewers for their time and input, which undoubtedly improved the quality of our studies.

Author Contributions

All authors claim authorship, and have approved and made substantial contributions to the conception, drafting and final version of the paper.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Quality of Life - Biopsychosocial Perspectives

Quality of Life

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Catholic University of the Sacred Heart , Italy

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Published 07 October 2020

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ISBN 978-1-78985-208-0

Print ISBN 978-1-78985-207-3

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Copyright year 2020

Number of pages 284

This book is a collection of chapters addressing various aspects of quality of life and health psychology from a biopsychosocial perspective. Chapters cover crucial issues, both clinical and social. Starting with an analysis of the concept of quality of life as it is described by the World Health Organization, subsequent chapters of the book examine the biological, psychological, social, and spiri...

This book is a collection of chapters addressing various aspects of quality of life and health psychology from a biopsychosocial perspective. Chapters cover crucial issues, both clinical and social. Starting with an analysis of the concept of quality of life as it is described by the World Health Organization, subsequent chapters of the book examine the biological, psychological, social, and spiritual issues related to the concept. The book explores how health, climate, psychiatric diseases, and social conditions of specific geographical areas can impact quality of life.

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Quality of Life, Essay Example

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Quality of life is a multidimensional notion that is associated with person’s happiness and satisfaction which are in their turn connected with a person’s physical and mental well-being and environment. Viewed broadly, the quality of life comprises such aspects as culture, rights, values, aspirations, social status etc. However, in this paper we will view health-related quality of life which heavily depends on the quality and accessibility of healthcare, ecology and people’s lifestyles. Health-related quality of life is a multilateral issue which may appear elusive in estimation. Some methods of estimating health-related quality of life include global assessments (people are asked to rate their health on a particular scale), healthy days survey (the number of days out of the past 30 when people felt mentally or physically unwell), years of healthy life survey (it calculates the years of life by an individual in optimal health to compare the number with average life expectancy), and life expectancy estimation.

Quality of life is closely connected with health improvement policies, campaigns and services at all levels – global, national, community and individual. It is directly determined by the state’s healthcare ability to fight infectious and chronic diseases, control tobacco use and substance abuse, provide immunization and access to healthcare, raise the population’s health literacy, and create a generally healthy environment. Health improvement is immediately connected with life expectancy rate and the quality of life in older age that is usually associated with the appearance of chronic and other diseases.

For ease of estimation and managing, certain determinants of health have been outlined and the connection between them defined. Individual’s health depends first of all on his/her biology, i.e. inheritance, a complex of physical and mental health problems acquired during life and lifestyle: a person’s diet, habits, physical activity, alcohol or drug abuse and other elements that change the initial picture of a person’s biology. The person’s lifestyle is such an outweighing factor that it is usually described separately as behavior. Behavior and biology are interconnected. While individual health depends on what a person does, some choices are predetermined by health level. This biology-behavior complex is in its turn influenced by physical environment – a person’s conscious or unwilling exposure to toxic substances, irritants, infectious agents, and physical hazards during his/her life. In the aspect of health improvement, physical environment is first of all connected with ecology and providing personal safety in homes, schools, and workplaces. Another important element is a person’s social environment. In some cases it is predetermined by a person’s biology (an individual born disabled may be likely to live in a specific community) and surely depends on the person’s behavior, i.e. choices. However, social environment influences the behavior and biology of a person, especially in terms of opportunities and expectations, the variety of social institutes and psychological comfort. Both physical and social environments are influenced by state policies and interventions at different levels: ecology, promoting healthy lifestyle, immunization campaigns, disease prevention policies etc. It goes without saying that policies and interventions are a result of the healthy-nation-building work of the social environment. Finally, individual health of every citizen depends on his/her lifetime access to quality health care, which is a result of social environment organization just like policies and interventions.

Both the statistics and my personal impressions support me in the idea that the population of our country and my community, which does not seem to differ much in the main parameters, are relatively healthy. 100% of the population both in cities and in the country are reported to be using adequate sanitation and 99% have access to improved water sources. Unfortunately, the access to healthcare is not as high (between 80 and 90%) and depends on having health insurance and income level. Strong connection between quality healthcare access and personal finances breeds health disparities and reduces the general health level. I feel that state financing should provide for a greater portion of healthcare services. Other health disparities include gender and racial ones and are connected with both biology of individuals and healthcare quality and access in each case.

I think we should be encouraged to go in for sports more actively since only 15% of all adults were reported to have enough physical activity in 1997. This figure is really alarming and logically results in high obesity rates (up to a quarter of the population is overweight) and, consequently, cardiac and other associated disease rates. We have quite big percentage of non-smoking sexually responsible population who are not prone to substance abuse and good perspectives to make the figure higher. To my mind, the areas of most urgent concern are financial policies in healthcare and promoting healthier lifestyles.

I consider myself a healthy, fit and health literate person. I have long been involved in regular exercising and cannot imagine myself leading an unhealthy life now. I drink little alcohol, have never tried drugs and do not smoke. I also have never experienced exposure to radiation or toxic substances. There is no history of serious hereditary diseases in my family. I live an active social life and have a rewarding profession, which means I feel comfortable in my social environment.

Healthy People 2010. A Systematic Approach to Health Improvement. Retrieved March 20, 2009, from http://www.healthypeople.gov/Document/html/uih/uih_2.htm

Healthy People 2010. Leading Health Indicators. Retrieved March 20, 2009, from http://www.healthypeople.gov/Document/html/uih/uih_2.htm

United States: Demographic Highlights. Retrieved March 20, 2009, from http://prb.org/Datafinder/Geography/Summary.aspx?region=72&region_type=2

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  1. Quality_of_Life_Its_definition_and_measurement

    thesis on quality of life

  2. 6. Assessing Quality of Life: Measures and Utility

    thesis on quality of life

  3. An Infographic Guide to Writing a PhD Thesis

    thesis on quality of life

  4. thesis (doc 179 KB)

    thesis on quality of life

  5. (PDF) International Journal of Life science and Pharma Research Impact

    thesis on quality of life

  6. The Expression of Life Quality Essay Example

    thesis on quality of life


  1. (PDF) The concept of quality of life

    • Quality of life is not standard of living, income or prosperity. • Some authors identify quality of life with HRQoL (Owczarek, 2010). Health is an important partial domain of quality...

  2. A systematic review of quality of life research in medicine and health

    Purpose. Quality of life (QOL) is an important concept in the field of health and medicine. QOL is a complex concept that is interpreted and defined differently within and between disciplines, including the fields of health and medicine. The aims of this study were to systematically review the literature on QOL in medicine and health research ...

  3. PDF A View of Quality of Life THESIS

    1.3 Defining quality of life for people with disabilities 1.4 Conclusion 2. Literature review 2.1 Introduction 2.2 Researching quality of life 2.2.1 Subjective versus objective measures of quality of life 2.2.2 Using a qualitative approach 2.2.3 Using a mixed methods approach 2.3 Disability and quality of life research in Ireland

  4. What does quality of life mean to older adults? A thematic synthesis

    QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains. Go to: Introduction

  5. Quality of Life and its Components' Measurement

    The objective of this paper is to define the quality of life (QOL) and the quality of working life (QOWL) con-ceptions and their components, to establish the quality of life evaluation...

  6. Assessing the Quality of Life in Elderly People and Related Factors in

    The aim of this study was aimed to examine the quality of life in elderly people in Tabriz, Iran in 2012. Methods: This cross-sectional study was carried out on 184 elderly people (male=97; female=87) with age ≥ 60 years. The participants surveyed in this study were elderly people who were living in the community and come voluntarily to the ...

  7. Quality of life of people with mental health problems: a synthesis of

    Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization. Conclusions

  8. Health-related quality of life and associated factors among patients

    A generic World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to measure the HRQOL. The data were analyzed by Stata version 12. Multiple Linear Regression analysis with P -value 0.05 was used to measure the degree of association between HRQOL and independent variables. Results

  9. PhD Thesis: A life course study of quality of life at older ages in a

    This thesis took a life course approach to examining inequalities in quality of life in early old age using the French occupational cohort GAZEL. The cohort combines company administrative records with information from annual questionnaires for 20 625 electricity and gas industry employees.

  10. Essays on the Quality of Life

    Topics range over quality of life investigations connected to the problems of combining social, economic and environmental indicators, measuring the status of women in Canada, housing and migration, health and human well-being, older peoples' well-being, leisure activities and health, impact of public services, police services, criminal ...

  11. Evaluating Quality of Life in Urban Areas (Case Study: Noorabad ...

    life, a valued life, a satisfying life, and a happy life (McCrea et al. 2006). In their extensive review of the literature on QoL, Mulligan et al. (2004) broadly interpret QOL as the satisfaction that a person receives from surrounding human and physical conditions, conditions that are scale-dependent and can affect the behavior of individual ...

  12. Quality of Life in Natural and Built Environment

    Quality of life (QOL) is a multifaceted concept used by a variety of disciplines and at different spatial levels. The theoretical aspect of QOL relates to happiness, life satisfaction and needs satisfaction approaches. It is a complex construct, and its measurement is multidimensional. QOL researchers use either objective or subjective ...

  13. Understanding Urban Sustainability and Quality of Life: A System

    Understanding Sustainability and Quality of Life: A System Dynamics Approach . by Abby Elizabeth Beck Dr. Krystyna Stave, Thesis Committee Chair Associate Professor of Environmental Studies University of Nevada, Las Vegas For an urban area to be sustainable, its resources cannot be depleted faster than they can replenish.

  14. Quality of Life for Patients with Dementia: A Systematic Review

    dementia and quality of life. The perspective and information in this research is not specific to a certain stage of dementia. Definition of Dementia . The Alzheimer's Association (2015) defines dementia as a "general term for a decline in mental ability severe enough to interfere with daily life." Alzheimer's disease

  15. Impact of Caregiving Role in the Quality of Life of Family Caregivers

    This study investigated quality of life of family caregivers of persons with Alzheimer's disease (AD). Caregiving is a strenuous and challenging job. Family caregivers experience poor quality of life after they take the role of caregiving which might be related to depression. Purpose of this study was to find if caregiving duration and

  16. (PDF) Doctoral Thesis "Quality of life in children and young people

    To achieve this goal, we conducted a broad study leading to the publication of four articles with the following specific objectives: (a) to test whether adolescents with a comorbid ASD diagnosis...

  17. Editorial: Nutrition and Health-Related Quality of Life: Is It an

    In the last three decades, a new dimension of QoL has increased in interest and has become known as the "health-related quality of life" (HRQoL) ( 2 ), which assesses how the individual's well-being may be affected over time, either as a result of a disease, disability or disorder.

  18. Quality of Life

    This book is a collection of chapters addressing various aspects of quality of life and health psychology from a biopsychosocial perspective. Chapters cover crucial issues, both clinical and social. Starting with an analysis of the concept of quality of life as it is described by the World Health Organization, subsequent chapters of the book examine the biological, psychological, social, and ...

  19. Candidate's Thesis: Quality of Life and Recurrence Concern in Survivors

    Objectives/Hypothesis A cohort of 3-year survivors of head and neck cancer was evaluated for persistent quality of life (QOL) concerns and long-term treatment effects.. Study Design Mailed questionnaire.. Methods The questionnaire with the University of Washington Quality of Life (UWQOL) scale, the Performance Status Scale for Head and Neck Cancer (PSS-HN), the Functional Assessment of Cancer ...

  20. P-151 Thesis: Quality of Life and functional outcomes after treatment

    Study III was a prospective cohort study investigating Quality of Life (QoL) and functional outcomes one-year after treatment for OPSCC in the same cohort as study II. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30), Head & Neck Module (EORTC QLQ-HN35), and ...

  21. (PDF) Urban Quality of Life: A Systematic Literature Review

    Quality of life (QoL) is a broad concept that has different definitions across diverse bodies of knowledge. The social-cultural environment and the characteristics of the built environment ...

  22. Quality of Life, Essay Example

    Quality of life is a multidimensional notion that is associated with person's happiness and satisfaction which are in their turn connected with a person's physical and mental well-being and environment. Viewed broadly, the quality of life comprises such aspects as culture, rights, values, aspirations, social status etc.

  23. INDICA on Instagram: "On the first Jayanti of Sri K Viswanath garu

    17 likes, 0 comments - indicaorg on February 19, 2024: "On the first Jayanti of Sri K Viswanath garu, Indica Pictures is proud to announce the prestigiou..."

  24. Teacher Quality of Life: Perspectives about Their Welfare

    Quality of life is the notion of a person on his life's situation including cultural perspective and value system. This also includes establishing an association with others and attaining of...