Rivernose the final report (long)

Mark · Tue Jan 27, 09 9:48 am **Rivernose the final report (long)**

I just received the final report on the Rivernose study some of us were involved with.
Here is the final report on Rivernose:
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Oregon Windsurfer and Kiteboarder Health Study Report
Background
Columbia River Gorge is a world-renowned destination for windsurfing and kiteboarding (“surfing”). Windsurfers and kiteboarders (“surfers”) have reported respiratory ailments and skin infections after surfing in the Columbia River Gorge in recent years. To delineate the kinds of symptoms reported and to evaluate potential health risks related to surfing in Columbia River Gorge, we surveyed a cohort of windsurfers, kiteboarders, and nonsurfers (i.e., persons who neither windsurf nor kiteboard) monthly during May–September, 2008.
Methods
Through surfer groups, posters, and public media, we recruited a convenience sample of surfers and healthy nonsurfers 18–70 years old. Nonsurfers had to be residents of Oregon or Washington in 2008. Surfers could be residents of other places as long as they would mainly surf in the Columbia River Gorge during our study period. One baseline and four follow-up surveys were administered monthly from May to September via the internet. In the baseline survey, we collected information on demographic characteristics, surfing characteristics (for surfers only), current chronic health conditions, and beliefs on the water quality in the Columbia River and Oregon Coast and the association between water quality and illness. In the follow-up surveys, we collected information on surfing activities (for surfers only) during the past month and last outing of surfing and incidence of primary health outcomes of concern. The primary health outcomes included upper respiratory symptoms (sinus infection or pain, stuffy or runny nose, and coughing), eye and ear infections, skin symptoms (skin rash, skin infection, and poor healing of wounds), and gastrointestinal symptoms (diarrhea, vomiting, and abdominal pain).
Incidence rates were calculated as symptoms per 100 person-months. Poisson regression models were used to compare symptoms among surfers and nonsurfers as well as among those who surfed in the Columbia River Gorge and those who surfed in other places during their last outing of surfing. The effect of sex, surfing month, and related
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Oregon Public Health Division—January, 2009
baseline health conditions (chronic sinusitis and pollen allergy adjusted for upper respiratory symptoms; cancerous or precancerous skin lesions adjusted for skin symptoms; chronic otitis adjusted for eye and ear infection) was adjusted for all multivariate models.
Statistically significant level was set at α=0.05, which means that if a P-value is less than 0.05, the difference is considered statistically significant.
Results
Baseline characteristics
Of 114 surfers and 94 nonsurfers enrolled, 86 (75%) surfers and 84 (89%) nonsurfers completed all five surveys. As shown in Table 1, surfers and nonsurfers were comparable at baseline in age, health status, and antecedent beliefs regarding an association of water quality with illness, but differed markedly with regard to sex, education, and residence. Compared to nonsurfers, a higher proportion of surfers were male and reported living in Hood River County. About one-third of surfers and nonsurfers rated the quality of Columbia River water “poor” or “very poor” (Table 1).
As shown in table 2, compared to nonsurfers, a higher percentage of surfers reported chronic sinusitis (16% versus 1%) and cancerous or precancerous skin lesions (10% versus 1%) (both P-value<0.001). Pollen allergy was the most commonly reported baseline health condition, with a prevalence of 32% among surfers and 26% among nonsurfers; this difference was not statistically significant. The prevalence rates of asthma and arthritis were less than 10% in both surfers and nonsurfers.
As indicated in Table 3, surfing-related characteristics of windsurfers and kiteboarders at baseline. Forty-four percent of surfers reported windsurfing, 39% reported kiteboarding, and 17% reported both. Nearly two-thirds of surfers reported windsurfing or kiteboarding for more than five years, and 75% of surfers reported having “advanced” or “professional” skills in windsurfing or kiteboarding. More than half of surfers reported dunking their head under water “very often” or “quite often.” Helmets and life preservers were the most commonly worn protective gear, but 51% of surfers seldom or never wore a helmet, and 70% seldom or never wore a life preserver. More than 90% of surfers
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Oregon Public Health Division—January, 2009
seldom or never wore an ear plug or nose clip. In terms of likelihood of taking risks when surfing, 28% surfers reported “almost always” seeking challenges.
Incidence of reported symptoms
During the follow up from June through September, upper respiratory symptoms were those most frequently reported by both surfers and nonsurfers. On average, each surfer reported 2.5 episodes of respiratory symptoms each month, 0.2 episodes of eye or ear infection, 0.5 episodes of skin symptoms and 0.3 episodes of gastrointestinal symptoms. Each nonsurfer reported an average of 0.6 episodes of respiratory symptoms each month, 0.03 episodes of eye or ear infection, 0.2 episodes of skin symptoms and 0.3 episodes of gastroenteritis symptoms. Among surfers, the incidence of each group of symptoms, and especially respiratory symptoms, peaked in June, declined in July and August, and reached its nadir in September. Among nonsurfers, no seasonal differences in the incidence of any group of symptoms were found (Table 4 & Figures 1-4).
Among respiratory symptoms, the incidence rate of stuffy or runny nose (lasting at least 24 hours per episode) was much higher than the incidence of sinus infection or of coughing. Ear infection was more common than eye infection. Among skin symptoms, poor healing of wounds and skin rash were more common than skin infection. Among gastroenteritis symptoms, diarrhea was more common than abdominal pain and vomiting. These findings applied to both surfers and nonsurfers.
Surfers were 3.9 times as likely as nonsurfers to report respiratory symptoms, 7.2 times as likely to report ear or eye infection, and 2.4 times as likely to report skin symptoms (Table 5). Surfers who reported pollen allergy at baseline were 80% more likely to report respiratory symptoms than those who did not report pollen allergy during the four-month period (P-value<0.001). Surfers who reported chronic sinusitis at baseline were 70% more likely to report respiratory symptoms than those who did not report chronic sinusitis (P-value<0.001).
As shown in Table 6, compared to surfing elsewhere during the last outing, surfing in the Columbia River Gorge was associated with a statistically significant 2.7-fold risk of developing respiratory symptoms. No statistically significant associations were found between surfing in the Columbia River Gorge and other symptoms.
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Oregon Public Health Division—January, 2009
Study limitations
This study has at least two limitations. First, the surveys were completed by a self-selected, convenience sample of windsurfers, kiteboarders, and non-surfers. The incidence rate estimates may not be generalizable to all surfers and the general public. Second, all estimates were based on self-reported data, and there was no validation of reported symptoms; in particular, we did not attempt to identify pathogens from reported cases of “infection.”
Conclusions
Windsurfers and kiteboarders reported higher rates of upper respiratory symptoms (especially stuffy or runny nose), ear or eye infection, and skin symptoms than nonsurfers. The incidence of upper respiratory symptoms among surfers was significantly higher in June and July than in August and September. Compared to surfing elsewhere, surfing in the Columbia River Gorge was associated with development of upper respiratory but not other symptoms. Among surfers, having allergy or chronic sinusitis was associated with a higher risk of respiratory symptoms.
The causes of the increased incidence of the aforementioned symptoms among surfers are unknown. Given that the primary upper respiratory symptom reported was stuffy or runny nose, that symptoms peaked in early summer and that they were associated with preexisting allergy, one plausible explanation is pollen allergens on the water. Environmental evidence on the seasonal change of pollen levels on the Columbia River may help to explain this hypothesis. Our findings also suggest that surfing in the Columbia River Gorge and other places might predispose surfers to infection, though mechanisms by which this might occur have not been studied.

jonah · Since 20 Jul 2006 169 Posts Hood River Stoked

buttersmoothcarver · Since 08 Oct 2008 246 Posts Stoked

"Given that the primary upper respiratory symptom reported was stuffy or runny nose, that symptoms peaked in early summer and that they were associated with preexisting allergy, one plausible explanation is pollen allergens on the water. Environmental evidence on the seasonal change of pollen levels on the Columbia River may help to explain this hypothesis."

this makes since, because I only get the river nose the first couple times I hit the water in the spring.

forrest · Tue Jan 27, 09 11:12 am

Have you tried any anti-histamines by chance?

pkh · Since 27 Feb 2005 6549 Posts Couve / Hood Honored Founder

saline nose spray has pretty much cured river nose for me.

blowhard · Since 26 Dec 2005 2026 Posts Windward