Environmental health with eight items deals with issues related to security, physical environment and financial support, accessibility of information, leisure activity, home environment, health, and transportation. All scores are transformed to reflect 4–20 for each domain with higher scores corresponding to a better QOL. There was no overall score for the WHOQOL-BREF and each domain was calculated by summation of their specific items. Where an item was missing, the mean of other items in the domain was inserted. Where more than two items are missing from the domain, the domain score was not calculated, except for domain 3, in which more than one missing item was required to discard the calculation.