Preface

Quality of life (QoL) is an important construct for health and wellbeing, with applications for clinical care, research, and individual or patient use. An assessment of QoL acknowledges the significance of modifiable and non-modifiable risk factors for health and disease (1, 2). QoL also has broader implications as a social and developmental concept. As defined by the World Health Organization (WHO), quality of life is "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns" (3). This definition takes cognizance of the subjective nature of QoL, and its immersion in the context of societal, cultural, and environmental norms.

With growing interest in QoL and the development of more comprehensive approaches to measurement, numerous methodologies and tools have been developed to measure Health-Related Quality of Life (HRQoL) and associated domains. The World Health Organization Quality of Life (WHOQOL) assessment measures this "multi-dimensional concept, incorporating the individual's perception of health status, psycho-social status and other aspects of life" (4). The WHOQOL-100 tool is a cross-cultural instrument that measures domains of physical, psychological, social relationships, environment, and spirituality/religion/ personal beliefs (4).

Section 1 of this book, "Quality of Life Indicators and Measurements," introduces the concepts of health-related quality of life (HRQoL) and the measures used in its assessment. Chapter 1, "Modifiers of Health-Related Quality of Life by Biological, Psychological and Social Factors" by Canelo, Lorenzo Gómez, De Sena, and Fernández-Martín, establishes the concept of HRQoL, reviews frequently used tools, and makes recommendations for their application in clinical care. This chapter offers a guide for clinicians, public health practitioners, and researchers.

Quality-adjusted life years (QALYs) measures years of life, adjusted for the QoL during those years. It serves as a measure of longevity and health outcomes (5). In Chapter 2, "Ethical Issues which Have Prevented the U.S. from Maximizing Quality of Life Years", the author Sage Arbor argues the value of QALYs for resource allocation and discusses the societal norms that challenge its effective utilization. The author highlights forces such as age, sex, lifestyle (e.g., smoking, drinking, obesity), cost transparency, and societal and demographic transitions (e.g., war, population explosion vs. collapse) that present ethical dilemmas for the use of QALYs.

Section 2, "Assessing Quality of Life in States of Chronic Diseases and Psychological Health," addresses HRQoL in the context of chronic diseases, including psychological dimensions and interventions. Chapter 3, "Assessment of Pain, Acceptance of Illness, Adjustment to Life and Strategies of Coping with the Illness in Patients with Pancreatic Cancer" by Religioni, Czerw, Badowska-Kozakiewicz, Budzik, and Deptała, reports on coping strategies and life adjustments for a sample of patients living with pancreatic cancer, the fourth most common type of cancer worldwide. In Chapter 4, "Predictors of Health-Related Quality of Life among Patients with

Diabetes Mellitus," Regassa Feyisa makes the for the need to measure HRQol for persons living with diabetes in Ethiopia. In this chapter, predictors of HRQoL were identified as age, sex, marital status, educational status, feelings of being stigmatized, co-morbidity status, chronic complication, and body mass index. In Chapter 5, "Quality of Life in Patients with Skin Disease and Their Cohabitants" by Montero-Vílchez, Sánchez-Díaz, Martínez-López, and Arias-Santiago, documents the significant impact of chronic skin diseases on QoL for both those directly and indirectly affected by skin conditions. The authors present a literature review of the psychological and social impact on both groups.

QoL assessments provide important tools for the quantitative and qualitative measurement of wellbeing and health outcomes. This book shares a global experience of QoL measures across various disease states and social environments, integrating developed and developing world reports. The findings shared by authors from across the globe may be informative for patients, healthcare providers, researchers,

The editors acknowledge the significant support of assistants to the editor Andrea Norman-McPherson of the University of the West Indies (UWI) School of Nursing, Mona at the UWI, and Mona J. Sue-Ho of the Jamaica Social Investment Fund in the

**Jasneth Mullings**

Marian University,

Kingston, Jamaica

**Tomlin Paul**

Faculty of Medical Sciences, The University of the West Indies,

**Sage Arbor and Medhane Cumbay**

Indiana, United States of America

University of the West Indies,

Mona Kingston, Jamaica

and policymakers alike.

completion of this work.

In Chapter 6, "Psychological Intervention Based on Psychoneuroimmunology in Children and Adult," Margarita del Valle Chacin Fuenmayor and Josymar Chacin de Fernandez describe the evolution of psychoneuroimmunology (PNI). This emerging field of study examines the contribution of the mind to the development of disease as well as prevention and treatment. The authors discuss the influence of stress on health and the role of PNI in managing disease and improving quality of life.

Section 3 presents "Quality of Life in the Context of the Social Gradient and Social Determinants of Health." Social factors are critical in the health determinants matrix and are shaped by economics, social policies, and politics. Undoubtedly, social resources influence QoL, significantly impacting population health outcomes. The evidence shows that health inequities are driven by social determinants, such as access to education, housing, income levels, and public safety (6). Furthermore, the concept of the social gradient where life expectancy is lower further down the social ladder is key to understanding the impact of poverty on health and QoL (7). Violence and exposure to the same is a byproduct of socioeconomic, cultural, and political forces and directly influences HRQoL. Globally, violence is recognized and treated as a public health problem and approaches to address it have largely been through the public health lens of identifying the causes and correlates, developing intervention interventions and public education programmes (8). An important aspect is a structural violence, which are those injustices embedded within social and institutional structures, which have been shown to drive health inequalities (9, 10), for example, disparities in education, income, and access to health and social resources (11, 12, 13) . Filiz Çömez Polat discusses the relationship between poverty and psychological processes in Chapter 7, "Poverty and Social Psychology: The Importance of Integrative Manner." The author argues the role of the empirical study of the social-psychological correlates of poverty in making a salient contribution to poverty reduction. In Chapter 8, "Zambia's Poorest Progressively Left Behind: Well-Being Denied," Brendan Carmody chronicles the history of the postindependence efforts of the Zambian government, which were aimed at revolutionizing the education system to secure greater equity, prosperity, and inclusiveness for the population. The chapter presents the challenges and deficiencies of the process, which the author argues has unfortunately opened the door to the marginalization of the majority.

The concluding chapter by Zanini Daniela, et al. "Living with Violence and its Relationship with Executive Function (EF) in Childhood and Adolescence: Literature Review," reviews the literature on the relationship between violence and the development of executive function in children and adolescents. The authors asserts that the evidence indicates that living with violence impairs the nuclear components of EF (i.e., working memory, cognitive flexibility, and inhibitory control) and makes the case for further research and public policy investments to stem the tide of violence.

QoL assessments provide important tools for the quantitative and qualitative measurement of wellbeing and health outcomes. This book shares a global experience of QoL measures across various disease states and social environments, integrating developed and developing world reports. The findings shared by authors from across the globe may be informative for patients, healthcare providers, researchers, and policymakers alike.

The editors acknowledge the significant support of assistants to the editor Andrea Norman-McPherson of the University of the West Indies (UWI) School of Nursing, Mona at the UWI, and Mona J. Sue-Ho of the Jamaica Social Investment Fund in the completion of this work.

> **Jasneth Mullings** Faculty of Medical Sciences, The University of the West Indies, Mona Kingston, Jamaica
