The IC magazine team interacted with the Centre of Excellence in Health Promotion and Rehabilitation in Estonia. Below are some excerpts from the interaction.

Can you share a bit about the objective of your centre?

The mission of the Centre of Excellence in Health Promotion and Rehabilitation, located in Estonia, Europe, is preserving and restoring the working capacity of the working-age population through research and development in the fields of curative mud treatment as well as mobility and operational capacity.

International Cooperation

The Centre of Excellence in Health Promotion and Rehabilitation was founded in Estonia, in 2011 on the basis of Tallinn University Haapsalu College. Its formation was supported by the regional preconditions of development in the fields of mobility and operational capacity (Haapsalu Neurological Rehabilitation Centre, Tallinn University Haapsalu College) and curative mud treatment (curative mud mining, traditions of mud treatment, spas in Estonia), which had the potential for international export. The partners of the Centre include organisations from the public and private sectors as well as universities (e.g. Tallinn University, University of Tartu, Tartu University Hospital, Haapsalu Neurological Rehabilitation Centre, Estonian Spa Association, spas, the municipality of Haapsalu).

Haapsalu Neurological Rehabilitation Centre (founded in 1958), a partner of the Centre of Excellence, offers high-level modern and evidence-based rehabilitation services that is founded on teamwork and participates in health studies. Altogether the hospital has a staff of 130 (doctors, nurses, physiotherapists, occupational therapists, speech therapists, psychologists, and social workers).

In the field of mobility and operational capacity the Centre develops cooperation with rehabilitation specialists from Europe and all over the world (cooperation partners thus far include for example Shriners Hospitals for Children Greenville South Carolina USA, Karolinska Institutet, Uppsala Universitet, Lunds Universitet, Sahlgrenska Academy at the Göteborg University Sweden, University of Nijmegen Holland).

In the field of curative mud treatment, international cooperation has been developed with, for example, the Baltic and North Sea Rehabilitation Association (Prof. Aivars Vetra from Riga University, Prof. Cristoph Gutenbrunneri from Hannover University); Prof. Elena Ilieva from Plovdiv University, General Secretary of the European Society of Physical and Rehabilitation Medicine; European Society of Physical and Rehabilitation Medicine, the leader of the Balneology group Prof. Pedro Cantista from Portugal; Prof. Jose Maria Carbajo (Instituto Nacional de Investigation of Madrid).

In addition, the Centre of Excellence in Health Promotion and Rehabilitation participates in international cooperation through its networks of partners connected to the Centre’s focus areas (such as the clusters Connected Health, SportEst, etc).

Laboratories of the Centre of Excellence in Health Promotion and Rehabilitation

The Centre’s research and development activities are conducted in its four laboratories: Mud Product Development, Health Promotion and Product Design Laboratories that are located in the same building with Tallinn University Haapsalu College and the Medical Rehabilitation Laboratory, equipped with excellent European-level high-technology equipment, in Haapsalu Neurological Rehabilitation Centre.

The Centre’s research and development in the field of curative mud treatment and the field of mobility and operational capacity are conducted mainly in the aforementioned four laboratories. In the period of 2012-2015 the Centre conducted 14 studies, based on which useful, applied product conceptions and solutions are created to further improve health products and services.

Research in the Field of Curative Mud Treatment, Useful Solutions

In 2012-2015 the Centre’s curative mud experts took samples from all of the five official mud deposits in Estonia and analysed them with an XRF device. The proportion of mineral and organic matter in the samples was determined. Altogether the database contains the data from the analyses of 145 samples, which have been thermogravimetrically analysed and whose content of organics, minerals and carbonates has been determined. In addition, 24 main chemical elements (Si, Al, K, Ca, Mg, Fe, Mn, Zr, Ti, Ba, Th, Nb, Sr, V), potentially toxic heavy metals (Pb, Ni, Zn, Cu, Cr, Cd) and non-metals (P, S, Br, Cl) have been determined.

As a result of the Centre’s organic and biochemical studies in the field of curative mud treatment, it has been ascertained that Estonian curative mud contains biologically active substances that cause its therapeutic effect and that Estonian curative mud does not contain substances harmful to the human body. The research results of the Centre in the field of curative mud treatment are an output for further product development and further application in medicine, pharmaceutical and cosmetic industry, etc.

From April 2013 to September 2014 over 150 industrial workers of Lääne County with work-related shoulder and arm overstrain were tested during the study “Assessing the curative effect of Haapsalu curative mud in the treatment of work-related musculoskeletal overload diseases and/or syndromes of working age population in developing new curative mud products/services”. The effects of general and local mud treatment as well as heat therapy were studied. In 10 procedures, patients with light to moderate musculoskeletal pain experienced a statistically significant improvement in blood circulation, proved by Laser Doppler. In addition, they experienced decrease in muscle strain, measured by a myotonometer. On the basis of the clinical studies conducted by the Centre of Excellence in Health Promotion and Rehabilitation, it can be said that balneological treatment, including mud treatment, is effective in the complex of early treatment of workers with overload pain.

These results show that spa treatment, including mud treatment, is suitable for working age patients with joint and muscle pain. In cooperation with occupational health specialists “Guide for mud treatment, heat therapy and hydrotherapy for work-related shoulder and arm overload syndrome” was completed.

In the second quarter of 2014 similar studies were conducted to explore the effect of Estonian lake mud on the analysis group with an early overload syndrome, with the aim of preventing the development of overload disorder. According to the study, treatment

schemes combined with general procedures were more effective for alleviating back and wrist pains. Treatment schemes that contained mud worked best for the elbow, and treatment schemes with mineral water or local heat therapy proved most effective for the shoulder. Neck pain reacted well to all combinations of heat therapy. In summary, spa treatment was effective as a combined treatment as well as local heat therapy.

From December 2012 to April 2014 a study of the quality of life following a six-day spa treatment was conducted in four Estonian spas with the aim of analysing the effects of a six-day spa treatment on the quality of life of patients with osteoarthritis of the knee at the end of their treatment and up to six months following the treatment. All the patients with the osteoarthritis of the knee whose health permitted the use of integrated treatment and who wished to participate, became study subjects in the order of their arrival. Altogether 374 people participated in the study. Treatment results between different mud treatment packages were assessed, based on the changes in clinical indicators. No statistically real difference can be seen between the mud treatment packages; thus, both mud treatment packages are suitable and there is no clear preference. In case of the mud treatment package that used a combination of mineral water and mud baths, the treatment effect could be observed later than in the case of using only curative mud, but the effects lasted longer.

Based on the studies of the Centre of Excellence in Health Promotion and Rehabilitation, we can claim that biologically active substances found in Estonian curative mud form an important foundation of the therapeutic effect in such cases as musculoskeletal overload diseases or syndromes.

Also, Estonian curative mud is suitable for product development in pharmacy and cosmetics. In cooperation with a pharmaceutical plant, the Centre has developed a massage cream that contains humid substances from the curative mud of Haapsalu. In the Centre’s Health Promotion Laboratory, we have tested both the curative mud massage cream as well as a mixture of mud and disintegrator-ground peat for vacuum massage, to introduce a new spa service.

In the field of curative mud treatment the Centre of Excellence in Health Promotion and Rehabilitation holds the patent “Therapeutic mud mixture and a method for its manufacture” (patent application number P201500002, letters patent number EE 05778 B1) and the patent “Electrical mud therapy device for limbs” (patent application number P201400009, letter patent number EE 05772 B1) – this is a patent for a mud therapy device for hands. The Centre’s Mud Products Development Laboratory has developed a solution that enables the transport of Estonian curative mud in a dried and disintegrator-ground form.

Can you elaborate about the research that is taking place at the centre and its facilities?

The Centre’s equipment, which contains a gait robot for children and adults, a robot-tilt table, an arm robot, a whole-body isokinetic dynamometer and stress test devices, is unique throughout Europe and enables the implementation of the Centre’s rehabilitation projects, and better planning of services and treatment results.

In 2012-2015 the following studies, which mainly supported entrepreneurship in rehabilitation, were conducted in the Rehabilitation Laboratory:

• The effectiveness of early rehabilitation (up to 1.5 years after the trauma) in achieving independence in patients with spinal cord injuries

• Rehabilitation, directing to active participation in the labour market and avoiding late complications in patients who have sustained spinal cord injuries over 1.5 years ago

• Improving the mobility and operational capacity of a stroke patient and a patient with traumatic brain injury

• Improving early rehabilitation and developmental treatment of children with neurological damage by introducing innovative treatment methodologies

• A health promotion study of school children aged 6 – 18 in early diagnostics of mobility and operational capacity (preventative action in the formation of working-age population)

• A study of the effects and applicability of vibroacoustic therapy in the rehabilitation of brain and spinal cord injuries

In addition, studies of posture problems and osteoporosis have been conducted in the Centre’s health laboratory.

The results of the studies conducted in the laboratories of mobility and operational capacity support new, innovative treatment methods in rehabilitation and developing assisting equipment that supports independent living through improving mobility and operational capacity and integrating disabled people into the labour market. The results of the studies are directed mainly at supporting the health promotion and preventative development activities of the Centre.

The vibroacoustic bed is an example of the applied solutions in the field of mobility and operational capacity. The bed, which is based on vibroacoustic therapy (VAT), was developed by a team of specialists of the Centre’s laboratories. The device for vibroacoustic therapy (VAT) or vibroacoustic bed, designed by the experts of the Centre’s Design Laboratory, has been confirmed as an industrial design solution (Community design Register, no 003004332-0001); in addition, software for the bed has been created.

The VAT device has an innovative ergonomic design, making it comfortable for the user as well as the person conducting the procedure. It is mobile, easily maintained, and aesthetically compatible with different environments. Potential end-users of the device include producers of medical and wellness products. The vibroacoustic bed is produced in Estonia under a licence agreement by the enterprise SMARTdo OÜ. The bed was presented at the International VIBRAC Conference in Finland in October 2016.[1]

In order to conduct research and development and implement useful solutions in curative mud treatment, mobility and operational capacity, the Centre of Excellence in Health Promotion and Rehabilitation is interested in international cooperation with entrepreneurs as well as universities.

Priit Aigro, a representative of SMARTdo, and Ivar Vinkel, an expert of the Centre of Excellence, introducing the VAT-bed. Photo: Piret Räni

Refernces:
[1] http://www.vibrac.fi/content/1st-international-vibrac-conference-0

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There are challenges in taking health as a core of the planning process in the cities. Lack of clear responsibilities in part of the municipalities, weak leadership for health, and missing procedures are only a few examples. This results in insufficient budget allocations. Economic challenges continuously overweigh health in decision–making, even if choosing correct actions could bring considerable savings. It is essential that the municipality or region knows the health situation in the respected area and has the resources and skills to analyse impacts of major policies from the health perspective. Political will and legal backing are also important in bringing cross- sectoral health promotion into practice.

Health promotion work needs innovations on the local level. Healthy Cities is a programme which encourages cities and municipalities for cross-sectoral work. Health and wellbeing should be put high on the agenda of the cities. Structures are needed to ensure the sustainability of the work. This means that all city functions must take health promotion into account. Education, transport, urban planning, culture and youth services should take residents’ health to their plans. It is advisable to build a cross-sectoral health and wellbeing board which follows the plans and activities. Healthy Cities is about involving all sectors.

Healthy Cities work in phases and the themes vary. Phase VI (2014-2018) themes are linked to European Health 2020 strategy. Thus, the topics are 1) improving health for all and reducing health inequities; and 2) improving leadership and participatory governance for health.

All in all, the health promotion work is connected to urban health. Urbanization is a trend all over the world. People move to cities as there are most of the jobs. Cities also have a wide variety of culture and possibilities for various types of housing. City life may – despite its benefits – bring aspects which are harmful to life. Loneliness, sedative lifestyle, pollution and lack of social belonging are serious problems which affect people’s lives. Cities should find innovative solutions to the challenges their people face over the life course.

European Health Challenges

Europe is facing big changes which affect the health of the population. Societies are ageing rapidly. Unemployment is a problem of young people and affects also persons in middle age and older. Migration changes the services needed. Urbanization means that planning becomes more challenging for cities. Ensuring the wellbeing of the population requires an open mind and readiness for cooperation. Municipalities have to start to combat the challenged together with companies and non-governmental organisations. World Health Organization is willing to help cities plan their work for the health of the residents. In Healthy Cities programme open local innovations are shared among the network members.

Western lifestyle is a threat to the society. The health data show that non-communicable diseases (NCDs) cause the biggest disease burden in all European countries. Illnesses such as diabetes, cancer, and cardiovascular diseases account for an ever larger share of fatal illnesses. This challenge is being faced by other parts of the world also.

In the Baltic Sea Region countries, non-communicable diseases cause about 80 % of deaths. These diseases are preventable and can be avoided by the modification of unhealthy lifestyles, e.g. healthy habits. Diets containing more vegetables, adequate physical activity and the avoidance of smoking should all be adopted. The national governments recognize this necessity in their health programmes and strategies. How they are implemented depends on the capacity of the municipalities, their politicians, public health administrators and methods of working. Healthy Cities programme states that unifying the efforts of different sectors and making health promotion not only effective otherwise but also cost-effective.

WHO Healthy Cities– How Did It Start?

For decades, United Nations organisations have traditionally worked with ministries and nations. Healthy Cities began as a World Health Organization project in 1987. It has over the years become a movement with very committed cities. The network has an annual business and technical conference and also runs several sub-networks. The WHO Healthy Cities programme has promoted cross-sectoral well-being effort as well as comprehensive and systematic policies and planning for health. The Healthy Cities movement is present in more than 30 European countries and over 1400 cities and regions.

Baltic Region Healthy Cities Association has served as a World Health Organization Collaboration Centre for Healthy Cities and Urban Health in the Baltic Region since 2002. The Association assists cities in implementing Healthy Cities’ goals and to build capacity for health and well-being. Furthermore, the Association is involved in health promotion projects, many of which concentrate on promoting cross-sectoral planning for health. The members of Baltic Region Healthy Cities Association include the City of Turku, University of Turku, Åbo Akademi University and the Social Insurance Institute of Finland. Baltic Region Healthy Cities Association – based in Turku, Finland – aims at increasing the awareness of local governments in adopting health as a central part of the decision-making process in municipalities.

Health inequities mean that differences in societies grow. In Europe, many people are doing well and live healthy and long lives. However, there are people whose health conditions are bad and they may be outside the society with no education. Despite several years of efforts to combat the inequities, the divide is only growing.

Coordinated Action Is Needed

Social and welfare costs remain to account for a very large share of both national and local budgets in all countries surrounding the Baltic Sea. Promotion of health and well-being requires coordinated action from all sectors of the society at national, regional and local level. It has been confirmed that investment in health promotion is cost-effective and that the best results are obtained if all sectors work together, taking into account the effects of policies on well-being. This means that, for example, education, economic and cultural sectors can strongly promote health. Also, traffic and environmental departments should enhance human well-being.

There are challenges in taking health as a core of the planning process in the cities. Lack of clear responsibilities in part of the municipalities, weak leadership for health, and missing procedures are only a few examples. This results in insufficient budget allocations. Economic challenges continuously overweigh health in decision–making, even if choosing correct actions could bring considerable savings. It is essential that the municipality or region knows the health situation in the respected area and has the resources and skills to analyse impacts of major policies from the health perspective. Political will and legal backing are also important in bringing cross- sectoral health promotion into practice.

Baltic Region Healthy Cities Association has accomplished numerous local health promotion projects. Recent themes in the projects include promoting volunteering of elderly people and thus making them participate in the society and find meaningful daily activities (www.letusbeactive.eu). Promoting children’s healthy habits is a theme of a project where the other partners are University of Turku, University of Tallinn Rakvere College and City of Jurmala in Latvia. One theme where the Association has been active is health literacy. It has been found that many Europeans lack understanding of health information. Health and welfare experts should pay special attention to understandable health information and ensure that guidance given is understood.

The World Health Organization definition of health says that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The challenge remains around the Baltic Sea and the rest of Europe to ensure health for all.

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