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Relationship between running performance and bone mineral density
Full text linkAbstract
Background: Bone mineral density (BMD) is a major determinant of fracture risk and overall skeletal health. Long‑distance running exposes bones to repetitive impact loads and is widely promoted for general health, yet previous studies have produced conflicting evidence regarding its effect on bone density. Some work suggests that distance running enhances BMD through mechanical loading, while others report reduced BMD at axial sites such as the lumbar spine.
Objective: To synthesize publicly accessible data from peer‑reviewed studies on running and bone density and to quantify relationships between running performance and BMD. We extracted and analysed data from open‑access articles available via PubMed and Google Scholar, focusing on differences between endurance runners and non‑athletes and the influence of age.
Methods: Three open‑access studies were identified. A 2019 cross‑sectional study comparing 68 marathon runners with 40 non‑active controls reported no difference in radial or tibial bone speed of sound but higher serum osteocalcin in runners[1]. A 2021 study of 103 high‑level endurance runners and 112 non‑athletes reported that female runners had higher leg BMD while male runners showed lower lumbar spine BMD[2]. A 2024 cross‑sectional study of 327 male runners and 212 inactive controls reported higher BMD in all lower‑limb segments but not upper‑limbs and noted that the BMD advantage decreased with age[3]. Data from the 2024 study were used to compute Cohen’s d and approximate point‑biserial correlations (r) between running status and BMD at various skeletal sites. Age‑specific BMD differences were analysed to examine associations between age and BMD benefit.
Results: In the 2019 study, runners averaged 48.6 ± 24.9 km per week and showed similar tibial and radial bone speed of sound to controls; however serum osteocalcin levels (a bone formation marker) were higher in runners (11–12 ng/mL versus 5–7 ng/mL)[1][4]. In the 2021 study, female runners exhibited ~4 % higher leg BMD than female non‑athletes, whereas male runners had ~9 % lower lumbar spine BMD but comparable total and leg BMD[2]. The 2024 study showed that runners had greater BMD at the whole body and lower‑limb sites (dominant leg: 1.26 ± 0.09 g/cm² versus 1.19 ± 0.10 g/cm²; nondominant leg: 1.26 ± 0.09 g/cm² versus 1.18 ± 0.10 g/cm²) but similar upper‑limb BMD[5]. Age‑stratified analysis revealed that the BMD advantage was largest in the 18–25 year group and diminished with age, with little difference in the oldest participants[6]. The computed effect sizes showed moderate positive correlations between running and lower‑limb BMD (r≈0.35–0.39) but weak correlations at the spine (r≈0.11–0.21) and upper limbs (r≈0.05) (Table 2). A scatter plot of dominant‑hip BMD difference versus age showed a strong negative correlation (r = −0.98) (Figure 1), indicating that the benefit of running on hip BMD declines sharply with age.
Conclusions: Weight‑bearing mechanical loading from running appears to enhance bone density in the lower extremities, especially in younger runners, while effects on axial sites are minimal or negative. High‑level male runners may exhibit lower lumbar spine BMD, potentially due to low energy availability or hormonal factors. Although running promotes bone formation markers, the magnitude of BMD improvement decreases with age and may depend on training volume and nutritional status. Future studies should consider individual running performance metrics (distance, pace and personal best times) and longitudinal designs to better quantify dose–response relationships between running and bone health
TRANSIT TO THRIVE: ADVANCING HEALTH, MOBILITY, AND OPPORTUNITY IN GRANVILLE AND VANCE COUNTIES BY EXPANDING KARTS ACCESS
Full text linkTransportation is a key social determinant of health (SDOH) in Granville and Vance counties, North Carolina, where access to safe, reliable, and affordable transit significantly shapes health outcomes and economic mobility. This proposal applies public health frameworks related to Engagement, Leadership, Policy, and Systems to recommend an equity-driven strategy to expand transportation access. Recommendations include increased county-level funding for the Kerr Area Regional Transportation System (KARTS), infrastructure investments in sidewalks and other safe travel options, and support for local economic development that reduces reliance on personal vehicles. Policy options were evaluated for equity, impact, sustainability, political feasibility, and cost. The priority population is the “sandwich generation”—adults aged 45–64 who care for both children and older adults. A cross-sector task force to be formed by County Commissioners is recommended to guide implementation and support upstream investment that can yield downstream benefits in health equity, cost savings, and community resilience.Master of Public Healt
Perceptions of cannabis warnings and recommendations for improvement: a qualitative study with people who use cannabis from the United States
Full text linkBackground Most states with legalized cannabis require warnings, but current cannabis warnings are unnoticed, difficult to read, and confusing. There is limited cannabis-specific research on which warning characteristics (e.g., size, content) effectively communicate the risks of cannabis use. This research explores perceptions of cannabis warning labels from a qualitative perspective. Methods We conducted six virtual focus groups (n = 36 participants) in March and April 2023 with U.S. adults (21+) who reported using cannabis in the past 30 days and resided in a state with legalized recreational cannabis. After exploring risk perceptions of cannabis products, participants were shown existing warnings on cannabis packages from states that have legalized cannabis and novel warnings on cannabis packages created by the study team and asked about cognitive and affective reactions. The resulting audio recordings were transcribed, and ATLAS.ti was used to perform thematic data analysis. Results Half of the participants identified as White, 22% as Black or African American, and 28% as another race. Participants’ mean age was 30.5 years, and, on average, participants reported using cannabis 3.7 of the past 7 days. Themes that emerged from the data were that participants perceived the purpose of warnings as accurately educating or promoting safe use: “I would say to inform people of the health risk so they can make an educated decision.” Participants did not notice existing warnings and wanted warnings to capture attention: “I’ve never noticed one […]” and “I would want some kind of a warning icon or symbol […].” Finally, participants were aware of both the benefits and risks of using cannabis: “I smoke for my anxiety” and “[…] I’ll get some sort of like paranoia.” Conclusions Our findings highlight areas for cannabis warning improvement, particularly with the warning content, design, and placement. Cannabis warnings that inform, educate, and guide less risky use may be well-received by people who use cannabis. More research is needed on the health effects of cannabis use to aid in the development of evidence-based cannabis warnings, particularly around mental health concerns
Blood-storage duration affects hematological and metabolic profiles in patients with sickle cell disease receiving transfusions
Full text linkPatients with sickle cell disease (SCD) frequently receive red blood cell (RBC) units stored near the end of their permissible storage life. To evaluate whether storage duration influences recipient metabolism, clinical chemistry and hematological parameters, we conducted a prospective, randomized, blinded trial comparing transfusions of RBC units stored for ≤10 days versus ≥30 days. Chronically transfused adults with SCD (N=24) received three consecutive outpatient transfusions with randomized-age RBCs, and blood samples from units and recipients were analyzed by metabolomics and clinical chemistry. Transfusion of short-stored units resulted in significantly higher circulating levels of 2,3-bisphosphoglycerate, an essential regulator of oxygen unloading, up to two weeks post-transfusion. Conversely, transfusions of long-stored RBCs were associated with lower hemoglobin and RBC increments, higher iron and transferrin saturation, pro-inflammatory cytokines and metabolites, oxidative stress and markers of renal dysfunction. Plasma and RBC metabolomic profiles revealed time- and storage-age-dependent alterations, particularly affecting glycolysis, purine, and sphingolipid metabolism. Transfusion of long-stored RBCs consistently worsened laboratory surrogates of oxygen delivery and RBC efficacy, and increased the circulating levels of immunomodulatory metabolites and pro-inflammatory cytokines. These findings highlight metabolic and hematologic advantages associated with transfusing fresher RBCs in adults with SCD, independent of immediate clinical outcomes
Study design and procedures for a hybrid effectiveness-implementation incomplete stepped-wedge cluster-randomized trial to evaluate a differentiated point-of-care HIV diagnosis and management model for the prevention of vertical transmission of HIV in Malawi: The PAC-Man trial protocol
Full text linkBackground In Malawi and elsewhere in Africa, many children living with HIV are unaware of their status, often because of missed services for the prevention of vertical transmission of HIV (PVTH). Pregnant and breastfeeding women (PBFW) living with HIV frequently go without viral load (VL) monitoring and their infants miss key HIV testing milestones for early infant HIV diagnosis (EID). In Malawi, the current standard of care (SOC) involves mostly passive approaches to pediatric HIV diagnosis, relying on mothers presenting to health facilities with their infants. To reach PBFW living with HIV and their infants who miss critical HIV services and who are at higher risk for adverse HIV outcomes, including vertical transmission, we developed the “Point-of-care Active Case finding & Management” or “PAC-Man” model. PAC-Man uses a multifaceted implementation strategy involving task-shifted mobile teams to reach these mother-infant pairs (MIPs) with evidence-based point-of-care (POC) technology for EID and maternal VL testing in the community, linked to back-to-care and antiretroviral therapy (ART) services. Methods We will conduct a hybrid type III effectiveness-implementation incomplete stepped-wedge cluster-randomized trial in 12 clinics in Malawi over a 3-year period to test our strategy. Control periods will reflect SOC. Intervention periods will add PAC-Man to SOC. The primary outcome is reach of infant EID testing by age 6 months in the clinic population. Secondary outcomes include the proportion of infants newly diagnosed with HIV initiating ART and maternal VL testing reach. These outcomes will be assessed using routinely collected clinic data augmented with field surveys enrolling a sample of MIPs randomly selected from each clinic. Implementation outcomes of acceptability, adoption, fidelity, implementation, sustainability, cost, and scalability will be assessed using convergent mixed methods. Discussion Study findings will offer new insights into the effects of differentiated, community-based services for reaching infants unaware of their HIV-positive status and their mothers and characterize the fit of the PAC-Man strategy with the national PVTH program. The study holds promise for improving access to EID and VL testing, and ART, for MIPs currently being missed by traditional facility-based approaches and could suggest a novel approach for use in real-world PVTH programs across Africa. Trial registration This study is registered at ClinicalTrials.gov, NCT06493357
"I was told it was the pill that suits me": A qualitative study of women's perceptions and experiences of medical reasons for non-preferred contraceptive use.
Full text linkBACKGROUND: People have contraceptive autonomy when they can obtain their preferred contraceptive method. Non-preferred method use may result from inappropriate medical contraindications, which occur when providers apply incorrect contraceptive eligibility criteria during consultations. Non-preferred method use and inappropriate medical contraindications are understudied in the Global South, partially due to measurement challenges. OBJECTIVES: This study provides the first evidence in over two decades that inappropriate medical contraindications are still a barrier to preferred method use in the Global South and offer a new conceptual frame for a neglected medical barrier to contraceptive use. DESIGN: We collected qualitative data from 49 in-depth interviews and 17 focus group discussions (n = 146) with women of reproductive age (15-49) in an anonymized African country. METHODS: We deductively identified instances of preferred method denial for medical reasons, then analyzed these episodes to determine whether the medical reasons for denial were evidence-based. RESULTS: We found that many women who reported preferred method denial described being offered medical reasons discordant with evidence-based guidelines, often resulting in what we determined to be contraceptive coercion. Specifically, we identified that (1) women experienced bi-directional contraceptive coercion with medical rationales, (2) women trusted providers' medical authority and felt unable to ask for more information, and finally, (3) women's personal reasons for their contraceptive preferences were rendered illegitimate by providers' use of biomedical language and (often incorrect) medical rationales. Consequentially, some women self-reported information indicating a legitimate contraindication to the non-preferred method their provider encouraged them to use. CONCLUSION: Inappropriate medical contraindications are an under-studied facility-level barrier to contraceptive access that can result in contraceptive coercion, negative health outcomes, discontinuation of wanted methods, and loss of reproductive autonomy. Addressing inappropriate medical contraindications will require solutions that negotiate both structural factors and individual provider behavior to improve the quality of contraceptive service provision
Effect of a pay-it-forward strategy on reducing HPV vaccine delay and increasing uptake among 15- to 18-year-old girls in China: A randomized controlled trial.
Full text linkBACKGROUND: Catch-up human papillomavirus (HPV) vaccination is challenging in many low- and middle-income countries (LMICs). Pay-it-forward offers an individual a subsidized vaccine, then an opportunity to donate to help others access vaccinations. Our randomized control trial assessed the effectiveness of pay-it-forward in improving HPV vaccination among girls aged 15-18 years in China. METHODS AND FINDINGS: This study was conducted from July 6, 2022, to June 9, 2023, in four community health centers (CHCs) in Chengdu, western China. Eligible participants were unvaccinated girls living in the service areas of CHCs. Participants were initially recruited via telephone and, after providing verbal consent, attended in-person visit where they were randomly assigned using the sealed envelope method to either the pay-it-forward arm (received a community subsidy of 47.7 USD covering the first vaccine and an opportunity to support others) or control arm (self-paid vaccination at the market price). Participants were unblinded only after the envelope was opened, while the CHC staff coordinators, physicians prescribing the vaccine, outcome assessors, and data analysts were blinded to the intervention allocation. The primary outcome was the first-dose HPV vaccination rate, verified against clinical records. Data were analyzed using the intention-to-treat approach. We identified 662 participants per phone invitation. A total of 321 participants showed up in the health centers and randomly assigned to the pay-it-forward arm (n = 161) or control arm (n = 160). Most caregivers were female (80.1%, 257/321). In the pay-it-forward arm, 55 of 161 (34.2%) girls received the HPV vaccine, compared with 28 of 160 (17.5%) girls in the control arm (adjusted proportion difference = 17.9%, (95% CI [8.7%, 27.0%]; P < 0.001). Among 55 girls in the pay-it-forward arm who received the vaccination, 37 (67.3%) wrote a postcard message, and 39 (70.9%) of their caregivers donated to support future girls. The financial cost per person vaccinated was 230 in the pay-it-forward arm. The trial had several limitations, including a 54% clinic attendance rate (360 of 662 consented participants attended) and its conduct in a single western province of China. CONCLUSIONS: The pro-social pay-it-forward strategy was effective to increase catch-up HPV vaccination among teenage girls. This approach also enhanced vaccine confidence among participants. Pay-it-forward demonstrates promise as an effective intervention to improve vaccine uptake through community engagement. TRIAL REGISTRATION: Chinese clinical trial registry ChiCTR2200055542 (https://www.chictr.org.cn/hvshowproject.html?id=183292&v=1.3)
North Carolina Public High School Websites: A Content Analysis And Digital Toolkit
Full text linkHigh school websites are essential communication tools, yet significant inconsistencies exist in their design, accessibility, and functionality. This study analyzed the websites of 100 public high schools in North Carolina, revealing common content trends and priorities but also navigation inconsistencies, low accessibility scores (averaging 54.2%), and poor mobile performance (averaging 43.5%). While 98% of sites were mobile-compatible, the study revealed a need for guidelines to help schools improve key accessibility issues, navigation, standardized content organization, and mobile design. To address these issues, this project applies user-centered design (UCD), user experience (UX), and user interface (UI) principles to develop a digital toolkit to help schools improve navigation, accessibility, and overall user experience. This resource aims to equip schools with practical strategies to create more inclusive, user-friendly websites, regardless of their available resources or technical expertise. Master of Arts in Digital Communicatio
A Best Practices Guide To Food Podcasting: How America’s Modern Culinary Community Is Teaching The Art Of Cooking And Food Appreciation
Full text linkFood podcasting has become a thriving genre in the U.S. podcasting space; as of early 2024, there were more than 13,400 food podcasts listed in the Apple Podcasts database. However, only about 20 percent of new podcasts ultimately survive. This thesis conducted a three-part content analysis of six leading food podcasts, examining program metrics, website user experience (UX), and content strategy. Publicly available data was analyzed alongside insights from informal conversations with podcasters, producers, and podcasting professionals. Findings reveal that unique content, strategic audience targeting, consistent production, strong UX design, and thoughtful branding all contribute to success. This study also highlights challenges around monetization and the need for community building. Results were used to develop a best practices guide for aspiring “foodcasters.” The six sample podcasts included in this study are: Dinner SOS (Bon Appétit); Proof (America’s Test Kitchen); Radio Cherry Bombe (The Cherry Bombe Podcast Network); Recipe of the Day (Cook the Story); The Splendid Table (American Public Media); The Sporkful (Stitcher Studios and SiriusXM).Master of Arts in Digital Communicatio
Alternative Kinship in the Wake of Absence: Women and Animals in the Politics of Feeding the Nation with Silent Flesh from Late Qing to Modern China
Full text linkThis thesis examines the relationship between women and animals through the approach of ecofeminism, focusing on how both are constructed as “absent referents” by the nation-state. By analyzing the dominant representations of pandas and women, I investigate how they are rendered invisible within state narratives. In the late Qing and early Republican period, Lü Bicheng, a pioneering female figure in animal protection within a nationalist framework, largely overlooked the subjectivity of animals. In contrast, contemporary “aunties” who care for stray animals established kinship bonds through embodied affect, thus challenging the nation-state’s logic of reproductive futurism. Ultimately, although women and animals are often constructed as absent referents within dominant discourses, their lived practices and affective connections offer alternative forms of kinship that resist and reimagine these structures.Master of Art