Apuramento de custos por utente nos cuidados de saúde primários

RESUMO - Introdução: A ausência de um plano de contabilidade analítica para os Cuidados de Saúde Primários é um problema para a realização da contabilidade interna, fundamental para a gestão de qualquer instituição de saúde. Sem linhas orientadoras para a uniformização dos critérios de imputação e distribuição dos custos/proveitos, torna-se complicado obter dados analíticos para que haja um controlo de gestão mais eficaz, que permita a utilização dos recursos de uma forma eficiente e racional, melhorando a qualidade da prestação de cuidados aos utentes. Objectivo: O presente projecto de investigação tem como principal objectivo apurar o custo por utente nos Cuidados de Saúde Primários. Metodologia: Foi construída uma metodologia de apuramento de custos com base no método Time-Driven Activity-Based Costing. O custo foi imputado a cada utente utilizando os seguintes costs drivers: tempo de realização da consulta e a produção realizada para a imputação dos custos com o pessoal médico; produção realizada para a imputação dos outros custos com o pessoal e dos custos indirectos variáveis; número total de utentes inscritos para a imputação dos custos indirectos fixos. Resultados: O custo total apurado foi 2.980.745,10€. O número médio de consultas é de 3,17 consultas por utente inscrito e de 4,72 consultas por utente utilizador. O custo médio por utente é de 195,76€. O custo médio por utente do género feminino é de 232,41€. O custo médio por utente do género masculino é de 154,80€. As rubricas com mais peso no custo total por utente são os medicamentos (40,32%), custo com pessoal médico (22,87%) e MCDT (17,18%). Conclusão: Na implementação de um sistema de apuramentos de custos por utente, é fulcral que existam sistemas de informação eficientes que permitam o registo dos cuidados prestados ao utente pelos vários níveis de prestação de cuidados. É importante também que a gestão não utilize apenas os resultados apurados como uma ferramenta de controlo de custos, devendo ser potenciada a sua utilização para a criação de valor ao utente.

Bioproduction of succinic acid from renewable feedstocks by Actinobacillus succinogenes 130Z

Succinic acid (SA) is a highly versatile building block that is used in a wide range of industrial applications. The biological production of succinic acid has emerged in the last years as an efficient alternative to the chemical production based on fossil fuels. However, in order to fully replace the competing petro-based chemical process from which it has been produced so far, some challenges remain to be surpassed. In particular, one main obstacle would be to reduce its production costs, mostly associated to the use of refined sugars. The present work is focused on the development of a sustainable and cost-e↵ective microbial production process based on cheap and renewable resources, such as agroindustrial wastes. Hence, glycerol and carob pods were identified as promising feedstocks and used as inexpensive carbon sources for the bioproduction of succinic acid by Actinobacillus succinogenes 130Z, one of the best naturally producing strains. Even though glycerol is a highly available carbon source, as by-product of biodiesel production, its consumption by A. succinogenes is impaired due to a redox imbalance during cell growth. However, the use of an external electron acceptor such as dimethylsulfoxide (DMSO) may improve glycerol metabolism and succinic acid production by this strain. As such, DMSO was tested as a co-substrate for glycerol consumption and concentrations of DMSO between 1 and 4% (v/v) greatly promoted glycerol consumption and SA production by this biocatalyst. Aiming at obtaining higher succinic acid yield and production rate, batch and fed-batch experiments were performed under controlled cultivation conditions. Batch experiments resulted in a succinic acid yield on glycerol of 0.95 g SA/g GLY and a production rate of 2.13 g/L.h, with residual production of acetic and formic acids. In fed-batch experiment, the SA production rate reached 2.31 g/L.h, the highest value reported in the literature for A. succinogenes using glycerol as carbon source. DMSO dramatically improved the conversion of glycerol by A. succinogenes and may be used as a co-substrate, opening new perspectives for the use of glycerol by this biocatalyst. Carob pods, highly available in Portugal as a residue from the locust bean gum industry, contain a significant amount of fermentable sugars such as sucrose, glucose and fructose and were also used as substrate for succinic acid production. Sugar extraction from raw and roasted carobs was optimized varying solid/water ratio and extraction time, maximizing sugar recovery while minimizing the extraction of polyphenols. Kinetic studies of glucose, fructose and sucrose consumption by A. succinogenes as individual carbon sources till 30 g/L were first determined to assess possible metabolic diferences. Results showed no significant diferences related to sugar consumption and SA production between the diferent sugars. Carob pods water extracts were then used as carbon source during controlled batch cultivations. (...)

A comparative review of risk based portfolio allocations: An empirical study throughout rising yields

Since the financial crisis, risk based portfolio allocations have gained a great deal in popularity. This increase in popularity is primarily due to the fact that they make no assumptions as to the expected return of the assets in the portfolio. These portfolios implicitly put risk management at the heart of asset allocation and thus their recent appeal. This paper will serve as a comparison of four well-known risk based portfolio allocation methods; minimum variance, maximum diversification, inverse volatility and equally weighted risk contribution. Empirical backtests will be performed throughout rising interest rate periods from 1953 to 2015. Additionally, I will compare these portfolios to more simple allocation methods, such as equally weighted and a 60/40 asset-allocation mix. This paper will help to answer the question if these portfolios can survive in a rising interest rate environment.