A question of continuing control -balancing building quality of housing and building codes

The Building Code of Australia seeks to establish “nationally consistent, minimum necessary standards of relevant, health, safety (including structural safety and safety from fire), amenity and sustainability objectives efficiently”. These goals are laudable – but where are the goals of quality and maintenance, which are also an essential part of achieving adequate and continuing health and safety for the built environment?

Defects such as dampness, settlement and cracking, staining, wood rot, termite damage, rusting, and roof leakage are common enough to suggest that there are still issues with building quality in housing. They are caused by a combination of initial poor workmanship and poor quality materials and latterly by poorly executed or inadequate maintenance.

Local architecture, developed over many years of trial and error, produce buildings linked to their climate and local materials (think of the typical “Queenslander” house). Today’s architecture imports technologies and materials from many differing countries and climates – that are not necessarily suitable for the location, nor is there necessarily the same quality control over the material quality and production. Inappropriate use and inadequate understanding of new materials and techniques can lead to the generation of further defects.

Whilst the building code contains provisions for initial-build material quality and workmanship, there is no continuing control over a house over its life span. Reliance is placed on advertising the need, for example, to employ qualified tradespeople; replace batteries in smoke detectors; and other good advice to help maintain housing to a minimum standard. Is this sufficient?

Mechanisms to make the transfer of knowledge to those who need to use it – be it the workforce or the houseowner – need to be improved. Should the building code be more visual and accessible in it’s content? Should the building code include provisions for maintenance? Should the building code require every house to have a “users manual” – much like a car? An extensive review of literature identifies the scale of the problem of poor quality housing and highlights some suggested causes – inadequate knowledge of the BCA by general housebuilders being one. However little work has been done to investigate what could be done to improve the situation. This work suggests that improvements to knowledge transfer would improve the quality of housing and a model of the knowledge transfer process is proposed, identifying those areas where the knowledge flows need to occur that would impact both the builders and users of housing.

Constipation, laxative use and diet

This study found that constipation estimates varied considerably from 9-42%, depending on the criteria used, and there was extensive laxative use. Those who were constipated reported a significantly poorer quality-of-life. Participants could not achieve current dietary recommendations and therefore managing constipation through dietary modification is impractical for many older people.

Effect of cow diet on the composition of milk for cheddar cheese manufacture

Seasonal milk production in Australia has a large impact on the manufacture of cheddar cheese, because the variable milk quality affects cheese moisture content and yield. The influence of cow diet on the composition of milk was investigated together with the effects of variation in milk composition on Cheddar cheese composition and yield. The composition of milk, especially the protein and mineral content, from cows offered diets comprising different energy and protein supplements was correlated with the composition and yield of Cheddar cheese produced.

Water quality modelling of the Barwon Water Supply System

An existing computer model (QUAL2E) was adapted to simulate the flow and water quality of the Barwon Water Supply System, the major water supply system for Geelong. Various water quality parameters were modelled and options reviewed for improving the water quality in this System.

Impact of chronic plantar heel pain on health-related quality of life

Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.

Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.

Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.

Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index.

The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.