Higher capital requirements and banks’ cost of capital : An empirical study of the Swedish major banks

In the wake of the financial crisis the systemic importance of banks for the stability of the financial system became evident. Finansinspektionen classifies the banks Nordea, Skandinaviska Enskilda Banken, Svenska Handelsbanken and Swedbank as systemically important for the Swedish financial system. The Basel accords strive to increase the resilience of banks and the financial system by imposing stricter regulatory capital requirements. It is debated how these restraints affect the banks’ cost of capital which prompt the first research question of the study: How has the increase in regulation regarding the capital structure of banks affected Sweden’s major banks’ cost of capital? According to Modigliani & Miller a firm’s cost of capital is independent of its capital structure. The second research question is thus: Does the development regarding Sweden’s major bank’s cost of capital align itself with the Modigliani-Miller theorem? The purpose of the study is thus to assess how the increase in regulatory capital requirements have affected the Swedish major banks’ cost of capital and to what extent these developments align with the Modigliani-Miller theorem. The researchers utilizes a quantitative method and collected secondary data for the period 2008 to 2016 to answer the formulated hypotheses which are deduced from the theoretical framework.   The results from the study illustrate significant correlations between increased regulatory capital requirements and the cost of capital. The authors can however not assert the irrelevance of capital structure for the banks’ cost capital but find that reduced tax shields only have modest effects on the banks’ cost of capital

Elevers delaktighet i planeringen i ämnet Idrott och Hälsa

Syfte Syftet med intervjuundersökningen var att ta reda på om eleverna medverkar i planeringen i ämnet Idrott och Hälsa och vad de kan påverka. Delaktighet har olika innebörder i olika sammanhang, delaktighet i yrkeslivet kan handla om arbetsmoral och delaktighet i skolan om integrering eller elevinflytande. Metod 6 elever i åk 4-6 intervjuades i en ostrukturerad intervjuundersökning där de först deltog i en gruppdiskussion. Från dessa sex elever gjordes ett urval där tre elever fick medverka i en personlig intervjuundersökning för att ta reda på hur väl eleverna kände sig delaktiga och vilket inflytande de hade i skolan i planeringen inom ämnet Idrott och Hälsa . Vid intervjutillfället användes papper och penna. Resultat Eleverna ansåg att läraren bestämmer det mesta i innehållet i ämnet Idrott och Hälsa. De aktiviteter eleverna hade varit med och planerat med läraren var olika lekar och bollsporter. Eleverna ansåg det var viktigt att de fick vara delaktiga på hur gruppindelningen skulle se ut. Uppvärmningen var en aktivitet som eleverna tyckte att de kunde utföra och planera själva varje lektion. Bollsporter var ett måste om eleverna själva skulle skriva om kursplanen

Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients

Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.Funding Agencies|NU Hospital Group, Department of Research and Development</p

A balance between meaningfulness and risk of harm - frail elderly patients perceptions of physical activity and exercise - an interview study

BackgroundThere is growing evidence of the benefits of physical activity and exercise for frail elderly patients with comorbidity. In order to improve participation in physical activity and exercise interventions, there is a need to increase our understanding of the patients perspective.AimThe aim of this study is to explore the perceptions of physical activity and exercise among frail elderly patients with a severe comorbidity burden.MethodFace-to-face, in-depth interviews were conducted with eighteen frail elderly patients with a severe comorbidity burden, median age 85.5years (min-max 75-94). The interviews were transcribed verbatim and analyzed according to content analysis inspired by Krippendorf.ResultsAn overall theme, defined as "Meaningfulness and risk of harm in an aging body" was identified, followed by three main categories, labeled physical activity in daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise, and eight sub-categories.ConclusionThis study suggests that, in frail elderly patients with severe multimorbidity, physical activity and exercise is a balance between what is perceived as meaningful and the risk of harm. Patients perceived aging as an inevitable process that they needed to accept and gradually adapt their physical activities in daily life to match. As patients said they were unclear about the benefits and risks of exercise and referred to their previous life and experiences when describing physical activity and exercise, it is likely that the communication relating to this within the healthcare system needs to be further developed To promote physical activity and exercise to maintain or improve physical fitness in this frail population, healthcare providers need to use extended, personalized information to tailor the type of physical activities, goals and prerequisites for each patient.Funding Agencies|Department of Research and Development, NU-hospital Group; Department of Research and Development Fyrbodal; Linkoping University Library</p

Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden

Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis. Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty. Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p&lt;0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032). Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.Funding Agencies|NU Hospital Group, Department of Research and Development</p

Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0

Abstract Background Worldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE. Methods An observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff’s alpha agreement coefficient test. Results The Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929–0.991) and a consistency value of 0.979 (95% CI: 0.953–0.994), which indicates excellent reliability. Krippendorff’s alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917–0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results. Conclusion The Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors