Paige Hornsby - Academia.edu (original) (raw)

Papers by Paige Hornsby

Obstetrical & Gynecological Survey, Oct 1, 1995

Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been associated w... more Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been associated with malformations of the genital tract in men. However, little is known about the fertility of men who have been exposed prenatally to diethylstilbestrol. In 1950 through 1952, 1646 pregnant women were enrolled in a randomized, placebo-controlled clinical trial of diethylstilbestrol at Chicago Lying-in Hospital. We interviewed men who were born to the women during that study about their fertility. Four decades after their birth, we were able to trace 548 of the surviving sons (68 percent). Ninety percent consented to be interviewed (253 who had been exposed to diethylstilbestrol in utero and 241 who had not been exposed). Congenital malformations of the genitalia were reported three times as often by the diethylstilbestrol-exposed men as by the sons of the women in the placebo group. Within the exposed group, malformations were reported twice as often among those exposed to diethylstilbestrol before the 11th week of gestation as among those exposed later (P = 0.05). Men with genital malformations were nonetheless as fertile as other men. The diethylstilbestrol-exposed men (with or without genital malformations) had no impairment of fertility by any measure, including whether they had ever impregnated a women, age at the birth of their first child, average number of children, medical diagnosis of a fertility problem, or length of time to conception in the most recent pregnancy of the female partner. Finally, diethylstilbestrol-exposed men had no impairment of sexual function, as indicated, for example, by the frequency of intercourse or reported episodes of decreased libido. High doses of diethylstilbestrol did not lead to impairment of fertility or sexual function in adult men who had been exposed to the drug in utero.

Gynecologic Oncology, Jun 1, 2016

still observed in black patients with ovarian cancer. Based on these data, tumor biology plays a ... more still observed in black patients with ovarian cancer. Based on these data, tumor biology plays a role in ovarian cancer racial disparity, and continued research is needed for determining the cause of this racial disparity.

American Journal of Obstetrics and Gynecology, 1995

As part of a larger health survey, we sought to determine whether prenatal exposure to diethylsti... more As part of a larger health survey, we sought to determine whether prenatal exposure to diethylstilbestrol is associated with onset of early menopause or menopausal symptoms. Diagnosis of premature ovarian failure and symptoms of menopause were determined in a telephone interview with 542 women whose mothers participated in a randomized clinical trial of the use of diethylstilbestrol in pregnancy in the early 1950s. These women were aged 37 to 39 at the time of the interview. Medical records were obtained to confirm diagnosis of premature ovarian failure. The prevalence of menopausal symptoms (specifically hot flashes and night sweats) did not differ for exposed and unexposed women. One exposed woman and no unexposed women had a medically confirmed diagnosis of premature ovarian failure. Prenatal diethylstilbestrol exposure was not related to diagnosis or symptoms of menopause in this study. Further follow-up will be necessary to determine if a difference in age at menopause emerges as these women become older.

American Journal of Obstetrics and Gynecology, Sep 1, 1995

We interviewed 542 women whose mothers were in a randomized trial of diethylstilbestrol. Effects ... more We interviewed 542 women whose mothers were in a randomized trial of diethylstilbestrol. Effects of diethylstilbestrol on the third generation were explored by ascertaining age at menarche for the women's daughters. A total of 123 daughters were > or = 10 years old (52 exposed and 71 unexposed). Age at menarche was unaffected by mother's prenatal diethylstilbestrol exposure.

Epidemiology, Mar 1, 1998

Epidemiology, Nov 1, 2008

Background-Menstrual discomfort is common among women of reproductive age and can be debilitating... more Background-Menstrual discomfort is common among women of reproductive age and can be debilitating. The accuracy of self-report of menstrual discomfort is unknown. Methods-At enrollment into the DES Reproductive Health Study, 1990, premenopausal women classified their frequency of any menstrual discomfort as "always", "often", "sometimes" and "never". Subsequently, women provided daily diary information for up to six months regarding any menstrual discomfort and medication for menstrual pain. Results-324 women contributed ≥4 menstrual cycles to the prospective study. At enrollment, 10% had reported "never" having menstrual discomfort. Of these, 65% recorded at least one day of menstrual discomfort during follow-up. For the 27% who had reported "always" having discomfort, 88% recorded discomfort in all cycles. The enrollment statement of discomfort was more strongly correlated with the percent of cycles in which women took medication for menstrual pain: respondents who said they "never" had menstrual discomfort reported use of pain medication in 3% of cycles; "sometimes," 36%, "often," 67%, and "always," 92%. The average number of days per cycle with prospectively-recorded menstrual discomfort was also correlated with the enrollment response. Conclusions-A single question regarding frequency of menstrual discomfort was positively correlated with prospectively recorded menstrual discomfort, and especially with pain requiring medication.

American Journal of Obstetrics and Gynecology, Mar 1, 1994

OBJECTIVES: The purpose of this study was to determine the effects of in utero exposure to diethy... more OBJECTIVES: The purpose of this study was to determine the effects of in utero exposure to diethylstilbestrol on the menstrual cycle. STUDY DESIGN: This was a prospective cohort study of 198 diethylstilbestrol-exposed women and 162 unexposed controls, recruited from women whose mothers participated in a randomized trial of diethylstilbestrol in pregnancy at the Chicago Lying-In Hospital from 1950 to 1952. Women with severe menstrual abnormality were excluded from the study. RESULTS: Diethylstilbestrol exposure was associated with a statistically significantly decreased duration of menstrual bleeding of approximately one half day and a lower average daily bleeding score (self-reported). We found no evidence for effects of diethylstilbestrol exposure on cycle length or variability of cycle length. Exposure was not related to symptoms of dysmenorrhea. CONCLUSIONS: The decreased duration and amount of menstrual bleeding among diethylstilbestrol-exposed women could be due to direct effects on the uterus. The lack of an effect on cycle length and variability appears to indicate that endocrine function is not grossly disturbed in those women studied.

The New England Journal of Medicine, May 25, 1995

Background. Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been ... more Background. Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been associated with malformations of the genital tract in men. However, little is known about the fertility of men who have been exposed prenatally to diethylstilbestrol. Methods. In 1950 through 1952, 1646 pregnant women were enrolled in a randomized, placebo-controlled clinical trial of diethylstilbestrol at Chicago Lying-in Hospital. We interviewed men who were born to the women during that study about their fertility. Results. Four decades after their birth, we were able to trace 548 of the surviving sons (68 percent). Ninety percent consented to be interviewed (253 who had been exposed to diethylstilbestrol in utero and 241 who had not been exposed). Congenital malformations of the genitalia were reported three times as often by the diethylstilbestrol-exposed men as by the sons of the women in the placebo group. Within the exposed group, malformations were reported twice as often among those exposed to diethylstilbestrol before the 11th week of gestation as among those exposed later (P ϭ 0.05). Men with genital malformations were nonetheless as fertile as other men. The diethylstilbestrol-exposed men (with or without genital malformations) had no impairment of fertility by any measure, including whether they had ever impregnated a woman, age at the birth of their first child, average number of children, medical diagnosis of a fertility problem, or length of time to conception in the most recent pregnancy of the female partner. Finally, diethylstilbestrol-exposed men had no impairment of sexual function, as indicated, for example, by the frequency of intercourse or reported episodes of decreased libido. Conclusions. High doses of diethylstilbestrol did not lead to impairment of fertility or sexual function in adult men who had been exposed to the drug in utero. (N Engl

American Journal of Infection Control, Oct 1, 2020

Clostridioides (formerly Clostridium) difficile is a major cause of healthcare-associated infecti... more Clostridioides (formerly Clostridium) difficile is a major cause of healthcare-associated infections [1,2]. Previous studies have investigated co-infection between Clostridioides difficile infection (CDI) and multidrug-resistant organism (MDRO) exposures, identified common risk factors including antibiotic use and dysbiosis, and compared measures of frequency [3-9]. However, none of the previous studies estimated risk or controlled for predisposing factors. The primary objective of our study was to assess ambidirectional association between MDRO colonization/infection and CDI in hospitalized adult patients through a case-control design. We calculated odds ratios and investigated three predisposing factors-age, antibiotic use, and comorbidities-in the association. A secondary objective was to assess directionality of the association. This study may inform current preventive practice against CDI. Methods Study Design Upon approval by the University of Virginia (UVA) Institutional Review Board, we conducted an ambidirectional case-control study. Each CDI case was matched 1:1 to a control whose negative CDI test date was within five days of the positive CDI test date. The first positive test date within the study period and the first negative test date of each hospitalization within the study period were eligible for case and control matching, respectively. Each patient was eligible to be matched once. We assessed MDRO exposure status from one year before to six months after the CDI. We included adult (18 years or older) inpatients who had tcdB PCR assay tests between May 1 and July 10, 2015. UVA Health System only allowed testing on patients with diarrhoea, defined as three loose stools

Diabetes and Metabolic Syndrome: Clinical Research and Reviews, May 1, 2019

Aim: Retrospective studies of firstepisode psychosis patients have reported that psychosis often ... more Aim: Retrospective studies of firstepisode psychosis patients have reported that psychosis often remains untreated for some time. Yet, from clinical samples, the characteristics and number of non-diagnosed untreated psychosis patients in a community can only be estimated. Thus, this short report compares sociodemographic and clinical features of diagnosed and non-diagnosed psychotic individuals assessed in the community. Methods: Using telephone interviews, we clinically assessed 2682 community participants (aged 16-40 years) in the Canton of Bern, Switzerland, to examine the characteristics of nondiagnosed psychosis. Results: Of the 41 detected psychosis patients (1.5% of the sample), 21 (54%) had already been diagnosed and treated. Non-diagnosed individuals experienced a delusional disorder (DD) (n = 10) more frequently than diagnosed individuals (n = 1), but did not differ in other socio-demographic characteristics. Conclusion: Further study of DD should be emphasized, along with increased awareness of the condition in primary healthcare services, as individuals with DD might present themselves for other complaints.

The Journal of Perinatal Education, 2022

This study aimed to identify unmet needs of mothers in the postpartum period. Semi-structured tel... more This study aimed to identify unmet needs of mothers in the postpartum period. Semi-structured telephone interviews were conducted two weeks postpartum with a convenience sample of 26 mothers who gave birth at an academic medical center. Topics included mothers’ concerns, levels of preparedness, educational needs and preferences during antepartum, labor and birth, and postpartum periods. Data were qualitatively analyzed using NVivo and a combination of open coding and theoretical coding, based on the Perinatal Maternal Health Promotion Model. Three major themes emerged: concerns, expectations, and positive coping strategies, with variations by previous maternal experience. Findings suggest the need for different models of care with more anticipatory, mother-centered care to better meet mothers’ needs and enhance postpartum outcomes and breastfeeding success.

There are many studies based on self-reported menstrual cycle length, yet little is known about t... more There are many studies based on self-reported menstrual cycle length, yet little is known about the validity of this measure. The authors used data collected in 1990 from 352 women born in Chicago, Illinois, aged 37–39 years. Women reported their usual cycle length and behavioral and reproductive characteristics at study enrollment and then completed daily menstrual diaries for up to 6 months. The authors compared this observed cycle length (geometric mean) with the reported length by using kappa coefficients. To assess systematic effects, they performed linear regression of the difference between reported and observed cycle length. Agreement between observed and reported cycle length was moderate. The crude overall kappa coefficient was 0.33; the kappa adjusted for within-woman sampling variability was 0.45 (95% confidence interval: 0.36, 0.55). On average, women overestimated their cycle length by 0.7 days (95% confidence interval: 0.3, 1.0). Reporting by sexually active women and...

Clinical Lactation, 2018

Background: The objective of this study was to test a breastfeeding history questionnaire to pred... more Background: The objective of this study was to test a breastfeeding history questionnaire to predict inhospital formula supplementation.Methods: A breastfeeding questionnaire named BAP, an abbreviation based on three questions, was conceptualized and implemented in clinical practice. Primary outcome was formula supplementation during the postpartum hospital stay.Results: Multiparous women with BAP scores of 1 or less were over four times more likely to use formula during the postpartum hospital stay than women with BAP scores of 2 or greater (RR = 4.35, 95% CI [2.47, 7.65]; p < .001). Additionally, multiparous mothers with BAP scores of 1 or less were more likely to use formula than primiparous mothers (RR = 1.93, 95% CI [1.47, 2.52]; p < .001). The adjusted odds of formula use were eight times greater for women with the lower BAP score (aOR 8.04, 95% CI [3.10, 20.86]; p < .001).Conclusions: The BAP tool can be used to identify multiparous women most at risk for early formu...

American Journal of Preventive Medicine, 1997

Breastfeeding Medicine, 2019

Background: Most women in the United States do not meet their breastfeeding goals, and low-income... more Background: Most women in the United States do not meet their breastfeeding goals, and low-income women breastfeed at lower rates than the general population. While risk factors for early cessation have been documented, specific reasons for discontinuing among this population are less understood. We examined reasons for cessation among low-income mothers to inform the development of targeted strategies to address breastfeeding disparities. Materials and Methods: We performed a secondary data analysis using prospective data collected during a randomized intervention trial of Women, Infants, and Children (WIC)-eligible women interviewed in the third trimester and at 1, 3, and 6 months postpartum. We included the 221 women who initiated breastfeeding and stopped by 6 months. Women's reasons for discontinuing breastfeeding were grouped by thematic category and compared by time of breastfeeding cessation. Results: The most common reasons reported overall for breastfeeding cessation were concerns about breast milk supply and latch difficulty. Some reasons differed significantly by time of cessation. Latch difficulty was reported most often by women who breastfed for 1 month or less; supply concerns increased with increasing breastfeeding duration. Returning to work/school was uncommonly reported for those who stopped by 1 month, but more frequently reported in those with later cessation. Conclusions: We found that low-income women reported similar reasons for early breastfeeding cessation as have been reported for other populations of women. These results underscore the need for appropriately timed, culturally sensitive interventions to reduce disparities in duration of breastfeeding, specifically to address latch difficulty in the first few weeks and supply concerns as infants grow.

Breastfeeding Medicine, 2018

BACKGROUND Many women initiate breastfeeding but do not meet their duration goals, and low-income... more BACKGROUND Many women initiate breastfeeding but do not meet their duration goals, and low-income women initiate and continue breastfeeding at lower rates than their counterparts. One-on-one counseling is associated with increased breastfeeding but requires significant resources. In contrast, video education, which requires fewer resources and is effective in other health care settings, such as vaccine uptake, has gone untested for prolonging breastfeeding duration among low-income women. OBJECTIVE To determine whether use of an educational breastfeeding video shown individually to low-income pregnant women in the prenatal clinic would prolong duration of any and exclusive breastfeeding. METHODS A multicenter, randomized, controlled trial was conducted in four prenatal clinics. Low-income pregnant women were randomized to view the intervention (breastfeeding education) or control (prenatal nutrition) video in the third trimester and interviewed by telephone at 1, 3, and 6 months postpartum about infant feeding practices. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression were utilized to compare groups. RESULTS Of the 816 eligible women approached, 64% participated: 263 assigned to the intervention, and 259 assigned to the control. Six-month data were obtained for 211 (80%) and 220 (85%) women, respectively. Rate of breastfeeding cessation did not differ by group (hazard ratios; HR = 1.00, 95% confidence interval [CI]: 0.81-1.24 and HR = 0.93, 95% CI: 0.76-1.14, for any and exclusive breastfeeding, respectively). CONCLUSION A single viewing of a breastfeeding education video shown in the prenatal clinic did not impact breastfeeding duration or exclusivity among low-income women in this study. Although not sufficient alone, educational videos may be useful as one component of a comprehensive program to promote breastfeeding.

Breastfeeding Medicine, 2014

Background: Low-income women have the lowest rates of breastfeeding in the United States. Greater... more Background: Low-income women have the lowest rates of breastfeeding in the United States. Greater understanding of factors that predict intention to feed artificial breastmilk substitute is needed to inform the design and timing of interventions to promote breastfeeding among vulnerable women. This study aimed to identify demographic and reproductive characteristics and other factors associated with intent to feed artificial breastmilk substitute among low-income women. Materials and Methods: Data from 520 low-income women interviewed at 24-41 weeks of gestation during enrollment in a prenatal breastfeeding education intervention study were analyzed. Participant characteristics, reasons for feeding decision, and sources and types of information received were compared among women intending to feed only artificial breastmilk substitute and other women. Results: Most participants (95%) had already chosen an infant feeding method at the time of interview. There were no differences in plans to return to work by feeding plan. Women reporting intention to feed only artificial breastmilk substitute were less likely to report receiving information about the benefits of breastfeeding, how to breastfeed, and pumps and were more likely to cite personal preference and convenience as reasons for their decision. Women were more likely to intend to feed artificial breastmilk substitute if they had a previous live birth or had not breastfed a child, including the most recent. Conclusions: These findings suggest breastfeeding promotion should target women early and include sensitive, effective ways to promote breastfeeding among women who have not previously successfully breastfed. Breastfeeding history should be elicited, and plans to pump should be supported prenatally.

Breastfeeding Medicine, 2012

This study surveyed the prevalence of bottle versus breastfeeding graphic images on products mark... more This study surveyed the prevalence of bottle versus breastfeeding graphic images on products marketed for pregnant mothers and young children available for purchase in national chain stores. This was a product survey/content analysis. Eighteen national chain stores located in a 10-mile radius of Charlottesville, VA were visited. In total, 2,670 individual items in 11 categories of baby shower and baby gift merchandise (shower invitations, greeting cards, gift wrap, shower decorations, baby dolls, baby books, infant clothing, bibs, nursery decorations, baby blankets, and disposable diapers) were assessed. The main outcome measures were prevalences of baby bottle and breastfeeding graphic images. Baby bottle images were found on products in eight of the 11 categories of items surveyed. Thirty-five percent of baby dolls were marketed with a baby bottle. The prevalence of bottle images on items in all other categories, however, was low. Of the 2,670 items surveyed, none contained a breastfeeding image. The low prevalence of baby bottle images on commonly purchased baby gift and baby shower items is encouraging. However, the absence of breastfeeding images and the relatively high prevalence of baby dolls marketed with a baby bottle demonstrate that breastfeeding is not portrayed as the physiologic norm on these products. Product designers should explore ways to promote breastfeeding, consumers should make informed choices in product selection, and advocacy groups should promote guidelines for these products.

Annals of Nutrition and Metabolism, 2012

Complementary food is needed when breast milk (or infant formula) alone is no longer sufficient f... more Complementary food is needed when breast milk (or infant formula) alone is no longer sufficient for both nutritional and developmental reasons. The timing of its introduction, therefore, is an individual decision, although 6 months of exclusive breastfeeding can be recommended for most healthy term infants. The new foods are intended to ‘complement’ ongoing breastfeeding with those dietary items whose intake has become marginal or insufficient. Both breastfeeding and complementary feeding can have direct or later consequences on health. The evaluation of consequences of both early and late introduction of complementary food can neither disregard the effect of breastfeeding compared to formula feeding nor the composition or quality of the complementary food. Possible short-term health effects concern growth velocity and infections, and possible long-term effects may relate to atopic diseases, type 1 and 2 diabetes, obesity and neuromuscular development. On the basis of the currently ...

American Journal of Epidemiology, 1989

A total of 91 women provided reproductive histories, including usual frequency of coitus, at thei... more A total of 91 women provided reproductive histories, including usual frequency of coitus, at their enrollment into prospective studies conducted by the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina, in 1984-1986. Those data were compared with coital data recorded during study participation. Overall, women reported a significantly higher frequency of coitus on the interviewer-administered questionnaire than they recorded daily, by an average of 0.8 episodes per week. The size of this difference did not vary significantly for subgroups of women defined by demographic and other covariates. Excluding days of menses from the prospective records reduced the difference by 25%. The authors attribute the overestimate on the questionnaire to a tendency to report a coital frequency that might exist in the absence of travel, illness, and other transient factors that are likely to decrease frequency. This nondifferential information bias is unlikely to produce misleading comparisons or erroneous associations in epidemiologic studies of reproduction.