Early treatment in asthma: How early is early?

ABSTRACTIn the 1990s, the definition of asthma changed as we realized that asthma is fundamentally an inflammatory disorder. It was also shown in both adults and children that treatment should be initiated with antiinflammatory medication (preferably inhaled steroids) and delayed treatment may worsen lung function outcome. There is increasing evidence that, in both children and adults, early and effective therapy with inhaled steroids results in long-term remission in the majority of patients. In future, even intermittent asthma symptoms will be treated with inhaled steroids. The first signs of asthma should be treated effectively, even in small babies. In children with atopic dermatitis, early pharmacotherapy may prevent asthma and in children with hay fever, specific immunotherapy may reduce the asthma risk. Airway eosinophilia predisposes a patient to asthma. The benefit of early intervention in patients who show eosinophilic airway inflammation but have normal or near normal lung function has been recently demonstrated. It seems that we should treat 'asthma even before asthma', if the disease is defined in terms of lung function. Persistent asthma is difficult to reverse, but early stages of asthma could be more responsive to novel therapies, such as drugs modifying the pro-inflammatory cytokines or monoclonal antibodies against IgE. The emerging new methods to assess airway inflammation will cast light on the origin of asthma, as well as on the determinants of disease persistence. Along with the development of practical inflammatory markers, the doctor gets a clearer picture of the disease. This means a better understanding for the doctor and better tailored treatment for the patient and this will further improve treatment results

Gamification of Education: Cities Skylines as an Educational Tool for Real Estate and Land Use Planning Studies

Computer games and other simulations have for a long time been used as a teaching method all around the world. They give a comprehensive, but simplified view of the reality to students with a hands-on approach to problems. Games as a teaching method offer competitiveness and a chance to see the results of decision-making in real time. These elements offer a different kind of inner motivation to learning, which usually is highly welcomed among students. Computer games give a contrast to the everyday not-so-interactive class teaching, and therefore have gained high popularity in schools and universities as a method for engagement.Cities Skylines is a city planning game that offers a simplified city planning experience, but also a surprisingly in-depth understanding of a city and its various functions. Alas, the planning system in the game is streamlined and does not include a realistic view of a city planning process with its multiple participants and developers. However, the city as a functioning system is well modeled and has some real potential for educational purposes. As a stand-alone game Cities Skylines does not fully meet the requirements for an educational game in the field of real estate or city planning. Nonetheless, the game is an exceptionally well developed platform and supports plethora of modifications. With a select few, well-thought modifications, the game would support educational uses, especially city planning problem solving using scenarios

Eläinallergiasta

English summaryPeer reviewe

Asuntotonttien kehitysarvojen ja myyntihintojen erot Helsingin seudulla.

The estimation of land values has been a topic in the real estate economics since the beginning of the field of study. Many governing theories of land value assume that the value of the location is capitalized in land value to the landowner and this should be reflected in the sales prices of land. In development projects, land value for the developer can be estimated using the residual valuation method, where the total development costs and the required development return are subtracted from the end-product value. The result is the highest price that a developer can pay for the land and stay profitable. The result of the residual valuation is often referred as the development value of the land. The purpose of this study was to use the residual valuation method to find out if there is a difference in the development value and sales price of residential land in the Helsinki metropolitan area (HMA). There are many previous studies about residential land values in the HMA, but a comparison of residual values and lot sales prices regionally is a new approach where there were no previous studies from Finland. The research data consisted of three independent datasets. Vacant lot sales data was provided by the National Land Survey of Finland, apartment price data was provided by Oikotie.fi and construction cost data was provided by Haahtela-kehitys Oy. The research would not have been possible without these key contributors. The apartment price data and construction cost data were used to calculate the residual land values that were compared to the lot sales prices. The results of the study show that there are significant differences in the residual land values and lot sales prices in the HMA. Residual land values have significantly higher differentiation between areas than lot sales prices. The residual land values ranged from 143 to 3,180 €/net apartment area while the lot sales prices ranged from 297 to 2,198 €/net apartment area. The larger differentiation of residual land values between the areas shows that the development value of residential land is not entirely represented in the land sales prices. This leads to a situation where it is possible for the developer to achieve higher than the minimum required development return by concentrating development on the areas that have the highest difference between the development value and sales price of land. The expected development returns correlate heavily with apartment price levels. Based on the results the highest expected development returns with the current land price levels can be achieved from inner city areas with the highest apartment prices in the HMA.Maan arvon määrittäminen on yksi kiinteistötalouden tutkituimmista aiheista ja sitä on tutkittu monin tavoin vuosien saatossa. Useat maan arvoon liittyvät teoriat lähtevät siitä, että kiinteistön sijainnin merkitys näkyy ensisijaisesti maan arvossa ja maan arvo on perustana tonttien myyntihinnoille. Kiinteistökehittäjän näkökulmasta kehityskelpoisen tontin arvo voidaan määrittää arvioimalla kehityksen lopputuotteen arvo ja vähentämällä tästä rakennuskustannukset ja kiinteistökehittäjän kate. Tätä menetelmää kutsutaan varsinkin englanninkielisessä kirjallisuudessa nimellä ”Residual valuation method”, eli suoraan suomennettuna residuaalimenetelmäksi. Residuaaliarvo on korkein hinta, jonka kiinteistökehittäjä voi maksaa tontista niin, että kehitysprojekti pysyy riittävän kannattavana. Residuaaliarvoa voidaan kutsua myös kehitysarvoksi ”development value”. Tämän tutkimuksen tarkoituksena on residuaalimenetelmää käyttämällä arvioida poikkeavatko tonttien myyntihinnat niiden kehitysarvoista Helsingin seudulla. Asuntotonttien arvoa on tutkittu Helsingin seudulla laajasti erilaisilla menetelmillä, mutta residuaaliarvojen ja tonttien myyntihintojen vertailusta ei löydy aiempaa Suomessa tehtyä tutkimusta. Tutkimusaineisto koostui kolmesta erillisestä tietolähteestä. Tonttien myyntihinta-aineisto perustuu Maanmittauslaitoksen keräämiin tietoihin, asuntokauppa-aineisto Oikotie.fi palvelun toimittamiin tietoihin ja rakennuskustannusaineisto Haahtela-kehitys Oy:n toimittamiin tietoihin. Tutkimuksen tekeminen ei olisi ollut mahdollista ilman näiden yhteistyökumppanien toimittamaa aineistoa. Asuntojen hinta-aineistoa ja rakennuskustannusaineistoa käytettiin residuaaliarvojen laskentaan, joita verrattiin tutkimuksessa tonttien myyntihintoihin. Tutkimustulokset osoittavat, että residuaaliarvot ja tonttien myyntihinnat poikkeavat merkittävästi toisistaan tutkimusalueilla. Residuaaliarvoissa on huomattavasti enemmän vaihtelua eri kaupunginosien välillä kuin tonttien myyntihinnoissa. Residuaaliarvot vaihtelivat välillä 143 – 3180 € / huoneiston nettoala, kun tonttien myyntihintojen vaihteluväli oli 297–2198 € / huoneiston nettoala. Residuaaliarvojen suurempi vaihtelu osoittaa, että asuntotonttien kehitysarvot eivät näy täysimääräisesti tonttien hinnoissa. Tämä johtaa tilanteeseen, jossa kiinteistökehittäjän on mahdollista saada minimivaatimuksia suurempia tuottoja kehityskohteista, jos kehitysalueet valikoidaan sen perusteella, missä tonttien myyntihinnat ja kehitysarvot poikkeavat eniten toisistaan. Laskennallisesti arvioidut kiinteistökehityksen tuotot korreloivat vahvasti asuntojen hintatason kanssa. Tutkimustulosten perusteella korkeimmat kiinteistökehityksen tuotot ovat saatavilla keskeisiltä kantakaupungin alueilta Helsingistä, joissa asuntojen hinnat ovat korkeimmillaan

Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement

T. Haahtela on työryhmien ARIA EPOS Working Groups jäsen.Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.Peer reviewe

Hunt for the origin of allergy - comparing the Finnish and Russian Karelia.

The Finnish and Russian Karelia are adjacent areas in northern Europe, socio-economically distinct but geoclimatically similar. The Karelia Allergy Study was commenced in 1998 to characterize the allergy profiles in the two areas. Allergy prevalence had increased in Finland since the early 1960s, but the situation in Russia was unknown. The key finding was that allergic symptoms and diseases were systematically more common in Finnish children and adults than in their Russian counterparts. For example, in the early 2000s, hay fever in school children was almost non-existent in Russian Karelia, and only 2% were sensitized to birch pollen compared with 27% in Finnish Karelia. Adult birth cohorts showed that among those born in the 1940s, the sensitization to pollens and pets was at the same low level in both countries, but among younger generation born in the late 1970s, the difference was already manifold. Seropositivity to some pathogens, microbial content in house dust and drinking water seemed to confer allergy protection in Russia. In subsequent studies, it became apparent that on the Finnish side, healthy children had a more biodiverse living environment as well as greater diversity of certain bacterial classes on their skin than atopic children. Abundance of skin commensals, especially Acinetobacter (gammaproteobacteria), associated with anti-inflammatory gene expression in blood leucocytes. In vivo experiments with the mouse model demonstrated that intradermally applied Acinetobacter protected against atopic sensitization and lung inflammation. These observations support the notion that the epidemic of allergy and asthma results from reduced exposure to natural environments with rich microbiota, changed diet and sedentary lifestyle. Genetic studies have confirmed strong influence of lifestyle and environment. With our results from the Karelia study, a 10-year National Allergy Programme was started in 2008 to combat the epidemic in Finland.Peer reviewe