Comparison of the use of life cycle assessment and ecological footprint methods for evaluating environmental performances in dairy production.

One popular methodology for assessing the environmental impact of livestock sector is Life Cycle Assessment (LCA), that quantifies the environmental impact of a product. Ecological Footprint (EF) performs an environmental sustainability assessment, by comparing the demand for natural capital by an economic activity with the offer of such capital within a certain territory. The aim of the study was the comparison between LCA and EF in assessing the environmental performances of milk production, assuming as case study three cattle farms with increasing levels of production intensity. Different metrics and functional units (FU) (i.e., fat and protein corrected milk, FPCM and hectare) were adopted for LCA analysis, considering some of the major impact categories. For greenhouse gases emissions, the Global Warming Potential (GWP) and the Global Temperature Potential (GTP) were considered. Both metrics were calculated assuming or not the distinction between biogenic and fossil methane. Adopting GWP as a metric, the results per kg of FPCM provided by the LCA highlighted a different trade off compared to the EF method: the farm with the highest productive intensity produced the least impactful milk in terms of GWP but had the most negative Ecological Balance (EB). The same occurred for the other impact categories. When GTP was adopted, or the hectare was considered as FU, the least intensive farm, characterized by greater feed self-sufficiency, became the one that produced the least impactful milk and had the least negative EB. The study highlighted the scientific significance of the integration between the two approaches for creating a comprehensive representation of the effects of human activities on the environment. The LCA method evaluates impacts intensity referred to a specific functional unit and its results are strongly influenced by productive efficiency; the EF method evaluates environmental sustainability of productions in relation to the territory that supports them.

PROPAT: a study to improve the quality and reduce the cost of diabetes care.

OBJECTIVE: In PROPAT we implemented an integrated approach to diabetes care designed to improve the quality and reduce the cost of care. STUDY DESIGN AND METHODS: PROPAT was a case-control study matching patients by age and gender (diabetes:control ratio 1:2) within IOMA, a public employment-based health maintenance organization (HMO) of the Province of Buenos Aires, Argentina. Costs were evaluated using prevalence data from an HMO perspective. We currently report clinical and biochemical data and costs from the first 297 patients enrolled who completed 1 year in PROPAT, and compare them with those derived from control patients. RESULTS: All recommended practices recorded as care provided at baseline increased significantly 1 year after implementing PROPAT, with a parallel significant improvement in several clinical and biochemical parameters, and markedly lower total annual per capita costs. CONCLUSIONS: These results demonstrate that the implementation of a comprehensive diabetes care program can simultaneously improve quality while reducing costs.

Hospitalization and re-hospitalization of people with and without diabetes in La Plata, Argentina: comparison of their clinical characteristics and costs.

OBJECTIVE: To examine the prevalence, characteristics, and costs of hospitalization and re-hospitalization of diabetic and non-diabetic patients in La Plata, Argentina, and to compare the data with those of developed countries. RESEARCH DESIGN AND METHODS: We studied all in-hospital registries of diabetic patients enrolled in a health maintenance organization of the Province of Buenos Aires (IOMA, November 1996). For each diabetic patient (127 persons), the characteristics of two other hospitalized non-diabetic patients matched by age and gender were simultaneously recorded. RESULTS: Of the 2200 recorded hospitalizations, 5.8% were for diabetic patients, accounting for 10.5% of the hospitalization cost. Cardiovascular diseases were the major cause of hospitalization in both groups. The per capita hospitalization cost of diabetic patients was significantly higher: 1628.5+/-1754.0 US dollars versus 833+/-842 US dollars; P=0.00002. Percent re-hospitalizations were five and a half times higher in diabetic patients (P=0.0001), and significantly associated with history of severe episodes of acute (odds ratio: 3.61; 95% CI: 1.11-11.70; P=0.03) and chronic (odds ratio: 4.26; 95% CI: 1.60-11.29; P=0.004) complications. CONCLUSIONS: The combination of higher and longer hospitalization rates and frequent re-hospitalizations resulted in increased costs for our diabetic population. Implementation of care programs based on education (for physicians and patients) could effectively decrease current and future costs of the disease.