S. Jean Emans

Harvard Medical School, Boston, Massachusetts, United States

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Publications (49)109.56 Total impact

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    ABSTRACT: The Life Course Perspective (LCP), or Model, is now a guiding framework in Maternal and Child Health (MCH) activities, including training, supported by the Health Resources and Services Administration's Maternal and Child Health Bureau. As generally applied, the LCP tends to focus on pre- through post-natal stages, infancy and early childhood, with less attention paid to adolescents as either the "maternal" or "child" elements of MCH discourse. Adolescence is a distinct developmental period with unique opportunities for the development of health, competence and capacity and not merely a transitional phase between childhood and adulthood. Adequately addressing adolescents' emergent and ongoing health needs requires well-trained and specialized professionals who recognize the unique role of this developmental period in the LCP.
    Maternal and Child Health Journal 02/2013; · 2.24 Impact Factor
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    ABSTRACT: To assess equity in compensation and academic advancement in an academic pediatrics department in which a large proportion of the physician faculty hold part-time appointments. The authors analyzed anonymized data from Vanderbilt University School of Medicine Department of Pediatrics databases for physician faculty (faculty with MD or MD/PhD degrees) employed during July 1, 2007 to June 30, 2008. The primary outcomes were total compensation and years at assistant professor rank. They compared compensation and years at junior rank by part-time versus full-time status, controlling for gender, rank, track, years since first appointment as an assistant professor, and clinical productivity. Of the 119 physician faculty in the department, 112 met inclusion criteria. Among those 112 faculty, 23 (21%) were part-time and 89 (79%) were full-time faculty. Part-time faculty were more likely than full-time faculty to be women (74% versus 28%, P < .001) and married (100% versus 84%, P = .042). Analyses accounting for gender, years since first appointment, rank, clinical productivity, and track did not demonstrate significant differences in compensation by part-time versus full-time status. In other adjusted analyses, faculty with part-time appointments spent an average of 2.48 more years as an assistant professor than did faculty with full-time appointments. Overall group differences in total compensation were not apparent in this department, but physician faculty with part-time appointments spent more time at the rank of assistant professor. This study provides a model for determining and analyzing compensation and effort to ensure equity and transparency across faculty.
    Academic medicine: journal of the Association of American Medical Colleges 06/2011; 86(8):968-73. · 2.34 Impact Factor
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    ABSTRACT: Heightened publicity about hormonal contraception and thrombosis risk and the publication of new guidelines by the World Health Organization in 2009 and the Centers for Disease Control and Prevention in 2010 addressing this complex issue have led to multidisciplinary discussions on the special issues of adolescents cared for at our pediatric hospital. In this review of the literature and new guidelines, we have outlined our approach to the complex patients referred to our center. The relative risk of thrombosis on combined oral contraception is three- to fivefold, whereas the absolute risk for a healthy adolescent on this therapy is only 0.05% per year. This thrombotic risk is affected by estrogen dose, type of progestin, mechanism of delivery, and length of therapy. Oral progestin-only contraceptives and transdermal estradiol used for hormone replacement carry minimal or no thrombotic risk. Transdermal, vaginal, or intrauterine contraceptives and injectable progestins need further study. A personal history of thrombosis, persistent or inherited thrombophilia, and numerous lifestyle choices also influence thrombotic risk. In this summary of one hospital's approach to hormone therapies and thrombosis risk, we review relative-risk data and discuss the application of absolute risk to individual patient counseling. We outline our approach to challenging patients with a history of thrombosis, known thrombophilia, current anticoagulation, or family history of thrombosis or thrombophilia. Our multidisciplinary group has found that knowledge of the guidelines and individualized management plans have been particularly useful for informing discussions about hormonal and nonhormonal options across varied indications.
    PEDIATRICS 02/2011; 127(2):347-57. · 4.47 Impact Factor
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    ABSTRACT: The academic successes of AM during the past 2 decades are marked by board certification, fellowship program accreditation, residency curricula creation, and the evolution of a remarkably respected scientific journal, the Journal of Adolescent Health. These same accomplishments have increased professional and public recognition of unmet population needs and the specialists who can help address them. The adolescent population is large, diverse, underserved, and characterized by increasingly complex medical and behavioral issues. Meeting their health care needs is a national priority. Primary care professionals who treat adolescents want and need adolescent-specific training in anticipatory guidance, screening, counseling, and management of common adolescent problems. A larger workforce of AM physicians is needed to provide this training, consult on complex medical and psychosocial issues when requested, and lead research efforts that will advance knowledge in the field. Developing this workforce will require improved recruitment into fellowship training; mentorship, policies, and resources that support trainee and faculty diversity; and articulation of the skills that define an AM physician.
    JAMA Pediatrics 12/2010; 164(12):1086-90. · 4.28 Impact Factor
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    ABSTRACT: Our objective was to determine the frequency of ovulatory salivary progesterone levels before menarche in healthy girls. We recruited a prospective cohort of midpubertal, premenarcheal girls. Participants collected weekly saliva samples until first menses or for 12 months. Menstrual cycles were considered to have ovulatory salivary progesterone levels if values were greater than 0.100 ng/ml (0.318 nmol/liter) 0-14 d before menarche. Participants collected saliva samples weekly at home and attended monthly clinic visits. Patients included 63 premenarcheal females, age 9-15 yr, with body mass index higher than the fifth percentile for age and Tanner stage III or greater for both pubic hair and breast development. Frequency of ovulatory levels of salivary progesterone before menarche was assessed. Fifty-five girls completed the study, and 43 experienced menarche. Of the 42 girls who reached menarche and provided a sample within 14 d of menarche, five (12%) had ovulatory progesterone levels. The mean anovulatory salivary progesterone level was 0.041 ng/ml (0.130 nmol/liter; range, 0.012-0.078 ng/ml, 0.038-0.248 nmol/liter), and the mean ovulatory level was 0.194 ng/ml (0.617 nmol/liter; range, 0.125-0.343 ng/ml, 0.398-1.09 nmol/liter). The levels of estrogen, testosterone, and 17-hydroxyprogesterone were higher and the mean BMI was lower in those with ovulatory progesterone levels vs. those with anovulatory levels. A significant proportion of girls displayed ovulatory levels of progesterone before menarche. More research is needed to clarify the hormonal events that occur in the perimenarcheal time period.
    The Journal of clinical endocrinology and metabolism 07/2010; 95(7):3507-11. · 6.50 Impact Factor
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    ABSTRACT: To address the critical shortage of physician scientists in the field of adolescent medicine, a conference of academic leaders and representatives from foundations, National Institutes of Health, Maternal and Child Health Bureau, and the American Board of Pediatrics was convened to discuss training in transdisciplinary research, facilitators and barriers of successful career trajectories, models of training, and mentorship. The following eight recommendations were made to improve training and career development: incorporate more teaching and mentoring on adolescent health research in medical schools; explore opportunities and electives to enhance clinical and research training of residents in adolescent health; broaden educational goals for Adolescent Medicine fellowship research training and develop an intensive transdisciplinary research track; redesign the career pathway for the development of faculty physician scientists transitioning from fellowship to faculty positions; expand formal collaborations between Leadership Education in Adolescent Health/other Adolescent Medicine Fellowship Programs and federal, foundation, and institutional programs; develop research forums at national meetings and opportunities for critical feedback and mentoring across programs; educate Institutional Review Boards about special requirements for high quality adolescent health research; and address the trainee and faculty career development issues specific to women and minorities to enhance opportunities for academic success.
    Journal of Adolescent Health 02/2010; 46(2):100-9. · 2.97 Impact Factor
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    ABSTRACT: Upper-extremity ovarian autologous transplantation was first used for girls undergoing abdominal/pelvic radiation therapy; long-term follow-up is provided. A case series. Tertiary pediatric medical center. Girls with Wilms tumor with planned abdominal/pelvic radiation therapy. Subjects 1, 2, and 3 (ages 5, 2, and 1 year) presented with a Wilms tumor and underwent surgical resection. Each patient underwent ovarian autotransplantation to move ovarian tissue out of the radiation field. Subjects 1 and 2 had thin slices from 1 ovary placed in the arm. Subject 3 had a free transfer of the entire ovary into an axilla. Follow-up was obtained for the subsequent 20-25 years for all 3 subjects. Pubertal, menarcheal, and menstrual history, and hormonal serum levels. All subjects survived and experienced spontaneous pubertal development and menarche. Data were available for follow-up for 20-25 years. Subjects 1 and 2 showed spontaneous follicular development of the autotransplanted ovarian tissue. They had fluctuating gonadotropin and estradiol levels until age 29 and 26, respectively; spontaneous menses until age 29 and 26; and cessation of spontaneous menses with elevated gonadotropins and low estradiol levels at age 30 and 26. Subject 3 had severe monthly axillary pain, and the ovary was transferred back to the pelvis. She then had ovarian dysfunction with intermittent spontaneous ovarian activity until age 25. Ovarian autotransplantation to the upper extremity resulted in long-term sex steroid production for spontaneous puberty, menarche, follicular development, and menses with fluctuating gonadotropin and ovarian sex steroid levels and follicular activity that lasted for 13-15 years.
    Journal of pediatric and adolescent gynecology 11/2009; 23(2):107-10. · 0.90 Impact Factor
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    ABSTRACT: Recent studies have reported gender differences in research grant applications and funding outcomes for medical school faculty. Our goal was to determine whether similar patterns exist at the resident level and, if so, to explore possible explanations. We conducted a retrospective review of all applications to an internal, mentored research grant fund at a large academic pediatric residency program from 2003 to 2008. We determined whether gender differences existed for application characteristics and outcomes and defined significant predictors of success. During the 5-year period, the fund supported 42 (66%) of 64 applications. Among all applicants, men were more likely than women to hold an advanced research degree. Men requested more money than women and obtained more favorable application scores. Funding success rates were not statistically different between male and female applicants. Among funded applicants, men received higher awards than women, although the percentage of requests funded was the same. In a multiple regression analysis, advanced degree was the significant independent predictor of successful funding outcome. Controlling for advanced degree attenuated the association between gender and timing of application, type of project, dollars requested, and dollars awarded; however, even after controlling for advanced degree, women had inferior grant scores compared with men. Gender differences existed in research grant applications and funding among pediatric residents that mirrored faculty patterns. Among residents, these differences were explained in part by the correlation of male gender with holding an advanced research degree.
    PEDIATRICS 09/2009; 124(2):e355-61. · 4.47 Impact Factor
  • Elise DeVore Berlan, S Jean Emans
    Journal of pediatric and adolescent gynecology 05/2009; 22(2):137-40. · 0.90 Impact Factor
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    ABSTRACT: Personally controlled health records (PCHRs) enable patients to store, manage, and share their own health data, and promise unprecedented consumer access to medical information. To deploy a PCHR in the pediatric population requires crafting of access and security policies, tailored to a record that is not only under patient control, but one that may also be accessed by parents, guardians, and third-party entities. Such hybrid control of health information requires careful consideration of both the PCHR vendor's access policies, as well as institutional policies regulating data feeds to the PCHR, to ensure that the privacy and confidentiality of each user is preserved. Such policies must ensure compliance with legal mandates to prevent unintended disclosures and must preserve the complex interactions of the patient-provider relationship. Informed by our own operational involvement in the implementation of the Indivo PCHR, we provide a framework for understanding and addressing the challenges posed by child, adolescent, and family access to PCHRs.
    Journal of the American Medical Informatics Association 09/2008; 15(6):737-43. · 3.57 Impact Factor
  • Frank M Biro, S Jean Emans
    Journal of Adolescent Health 08/2008; 43(2):103-5. · 2.97 Impact Factor
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    ABSTRACT: To evaluate whether there were differences in acquisition of research grant support between male and female faculty at eight Harvard Medical School-affiliated institutions. Data were obtained from the participating institutions on all research grant applications submitted by full-time faculty from 2001 through 2003. Data were analyzed by gender and faculty rank of applicant, source of support (federal or nonfederal), funding outcome, amount of funding requested, and amount of funding awarded. Data on 6319 grant applications submitted by 2480 faculty applicants were analyzed. Women represented 29% of investigators and submitted 26% of all grant requests. There were significant gender differences in the mean number of submissions per applicant (women 2.3, men 2.7), success rate (women 41%, men 45%), number of years requested (women 3.1, men 3.4), median annual amount requested (women $115,325, men $150,000), mean number of years awarded (women 2.9, men 3.2), and median annual amount awarded (women $98,094, men $125,000). After controlling for academic rank, grant success rates were not significantly different between women and men, although submission rates by women were significantly lower at the lowest faculty rank. Although there was no difference in the proportion of money awarded to money requested, women were awarded significantly less money than men at the ranks of instructor and associate professor. More men than women applied to the National Institutes of Health, which awarded higher dollar amounts than other funding sources. Gender disparity in grant funding is largely explained by gender disparities in academic rank. Controlling for rank, women and men were equally successful in acquiring grants. However, gender differences in grant application behavior at lower academic ranks also contribute to gender disparity in grant funding for medical science.
    Journal of Women s Health 04/2008; 17(2):207-14. · 1.42 Impact Factor
  • PEDIATRICS 03/2008; 121(2):390-401. · 4.47 Impact Factor
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    ABSTRACT: A total of 362 high school students were surveyed on supplement use, attitudes regarding supplements, information sources, and physical activity. Seventy-four percent of students used some type of supplement; 47.3% used vitamin C, the most reported traditional supplement; and 20.5% used ginseng, the most reported nontraditional supplement. Forty-eight percent of adolescents were introduced to supplements by their family and 52% took supplements for good health. Eighty-five percent of adolescents with a body mass index for age at the 85th percentile or greater used supplements to decrease weight and body fat. There was a direct correlation between the number of supplements used and the number of team sports an adolescent played (r = 0.12, P = .03).
    Topics in clinical nutrition 09/2004; 19(4):266–272.
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    ABSTRACT: Although vitamin D deficiency has been documented as a frequent problem in studies of young adults, elderly persons, and children in other countries, there are limited data on the prevalence of this nutritional deficiency among healthy US teenagers. To determine the prevalence of vitamin D deficiency in healthy adolescents presenting for primary care. A cross-sectional clinic-based sample. An urban hospital in Boston. Three hundred seven adolescents recruited at an annual physical examination to undergo a blood test and nutritional and activity assessments. Serum levels of 25-hydroxyvitamin D (25OHD) and parathyroid hormone, anthropometric data, nutritional intake, and weekly physical activity and lifestyle variables that were potential risk factors for hypovitaminosis D. Seventy-four patients (24.1%) were vitamin D deficient (serum 25OHD level, </=15 ng/mL [</=37.5 nmol/L]), of whom 14 (4.6%) were severely vitamin D deficient (25OHD level, </=8 ng/mL [</=20 nmol/L]). By using a broader definition (25OHD level, </=20 ng/mL [</=50 nmol/L]), 129 patients (42.0%) were vitamin D insufficient. Serum 25OHD levels were inversely correlated with parathyroid hormone levels (r = -0.29), and were 24% lower during winter compared with summer. In a final multivariate model, season, ethnicity, milk and juice consumption, body mass index, and physical activity were significant independent predictors of hypovitaminosis D. Vitamin D deficiency was present in many US adolescents in this urban clinic-based sample. The prevalence was highest in African American teenagers and during winter, although the problem seems to be common across sex, season, and ethnicity.
    Archives of Pediatrics and Adolescent Medicine 06/2004; 158(6):531-7. · 4.28 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate how adolescents and adults with cystic fibrosis (CF) view preventive counseling and their transition to adult-centered care within a children's hospital. Thirty-two patients >/=16 years old diagnosed with CF were recruited from a pediatric tertiary care setting. During face-to-face interviews, patients were asked 27 structured questions and completed a 30-item self-administered questionnaire on preventive counseling by healthcare providers and on transition issues. The median age of patients was 25.5 years (range, 16-43 years); 69% of patients identified a pulmonologist as their "main doctor," even though 78% had a primary care provider. Participants felt that 13-16 years of age was the best time for them to begin spending time alone with their main doctor. Less than half of the participants recalled receiving preventive counseling during the previous 12 months, and more patients wanted to discuss issues than actually did. Qualitative data emphasized the importance of independence in making decisions in healthcare and establishing relationships with providers, and many patients did not desire to transfer care to an adult hospital. Participants identified adult-focused services such as inpatient rooms, discussion groups, work options, and social service support that would enhance care. In conclusion, the majority of adolescent/young adult patients with CF receiving care in a pediatric institution reported satisfaction with their healthcare. However, patients identified preventive issues that they desired to be more regularly addressed, starting in early adolescence, and changes in the delivery of services to enhance transition to adult-oriented care. This study underscored the understanding of the integration of transition planning into the facilitation of healthcare decision-making by the adolescent in issues of self-care, sexuality, education, and finances. Future initiatives to enhance the care of patients with CF should provide training of pulmonologists in preventive care and increased attention to helping patients utilize appropriate primary-care services during the adult years. In addition, prospective studies are needed to compare outcomes of CF patients who have transitioned and transferred to adult hospitals and those transitioning to adult-oriented services in a pediatric institution.
    Pediatric Pulmonology 11/2003; 36(5):376-83. · 2.38 Impact Factor
  • Andrea Pettinato, S Jean Emans
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    ABSTRACT: The decline in adolescent pregnancy rates noted in the 1990s has been attributed to more teenagers choosing abstinence, the availability of long-acting contraceptive options, and the increased use of condoms. Many adolescents remain at risk of unplanned pregnancy, however, because of method failure, inconsistent or incorrect use, or discontinuation of a method without choosing another method. Practitioners who care for adolescents and young women have access to several new methods in 2003. Recent additions include a contraceptive transdermal patch, a hormone-releasing intravaginal ring, new formulations of pills, and a new intrauterine device. Additionally, the World Health Organization has updated its guidelines to provide the practitioner with evidence-based recommendations to assist in selecting the most appropriate contraceptive method for each patient.
    Current Opinion in Pediatrics 09/2003; 15(4):362-9. · 2.63 Impact Factor
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    ABSTRACT: Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits. Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return. The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (+/- standard deviation) was 18.3 (+/- 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78). Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.
    Obstetrics and Gynecology 04/2003; 101(3):490-9. · 4.80 Impact Factor
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    ABSTRACT: Young women with anorexia nervosa (AN) have subnormal levels of dehydroepiandrosterone (DHEA) and estrogen that may be mechanistically linked to the bone loss seen in this disease. The purpose of this study was to compare the effects of a 1-yr course of oral DHEA treatment vs. conventional hormonal replacement therapy (HRT) in young women with AN. Sixty-one young women were randomly assigned to receive oral DHEA (50 mg/d) or HRT (20 micro g ethinyl estradiol/0.1 mg levonorgestrel). Anthropometric, nutrition, and exercise data were acquired every 3 months, and bone mineral density (BMD) and body composition were measured by dual energy x-ray absorptiometry (DXA) every 6 months over 1 yr. Serum samples were obtained for measurements of hormones, proresorptive cytokines, and bone formation markers, and urine was collected for determinations of bone resorption markers at each visit. In initial analyses, total hip BMD increased significantly and similarly (+1.7%) in both groups. Hip BMD increases were positively correlated with increases in IGF-I (r = 0.44; P = 0.030) and the bone formation marker, bone-specific alkaline phosphatase increased significantly only in the DHEA treatment group (P = 0.003). However, both groups gained significant amounts of weight over the year of therapy, and after controlling for weight gain, no treatment effect was detectable. There was no significant change in lumbar BMD in either group. Both bone formation markers, bone-specific alkaline phosphatase and osteocalcin, increased transiently at 6-9 months in those subjects receiving DHEA compared with the estrogen-treated group (P < 0.05). Both DHEA and HRT significantly reduced levels of the bone resorption markers, urinary N-telopeptides (P < 0.05). There was a positive correlation between changes in IGF-I and changes in weight, body fat determined by DXA, and estradiol for both groups. In addition, patients receiving DHEA exhibited improvement on three validated psychological instruments (Eating Attitudes Test, Anorexia Nervosa Subtest, and Spielberger Anxiety Inventory). Both DHEA and HRT had similar effects on hip and spinal BMD. Over the year of treatment, maintenance of both hip and spinal BMD was seen, but there was no significant increase after accounting for weight gain. Compared with HRT, DHEA appeared to have anabolic effects, evidenced by the positive correlation between increases in hip DXA measurements and IGF-I and significant increases in bone formation markers. Both therapies significantly decreased bone resorption. Replicating results from studies of the elderly, DHEA resulted in improvements in specific psychological parameters in these young women.
    Journal of Clinical Endocrinology &amp Metabolism 11/2002; 87(11):4935-41. · 6.43 Impact Factor
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    ABSTRACT: To clarify the role of physiologic regulators of bone turnover in patients with anorexia nervosa (AN). Adolescent girls with AN (n = 61) had anthropometric, nutrition, and exercise data acquired, and bone mineral density (BMD) and body composition measured by dual energy x-ray absorptiometry. Serum samples were obtained for hormones, proresorptive cytokines, and bone formation markers, and urine for bone resorption markers. In bivariate correlation analyses, significant (P <.05) predictors of lumbar BMD included height, weight, and exercise. In multiple regression models, these significant relationships held, even after controlling for the duration of amenorrhea and AN. For total body BMD, the same positive predictors were found and percentage of body fat was a negative correlate. For hip BMD, exercise and weight were found to be positive predictors. Dehydroepiandrosterone sulfate (DHEAS) was inversely correlated with N-telopeptides (NTx), and insulin-like growth factor I (IGF-I) was directly correlated with osteocalcin. Proresorptive cytokine levels were low or undetectable. Exercise and weight were positive predictors of BMD. These data are the first to suggest a relationship between DHEAS and increased bone resorption in AN. IGF-I was correlated with bone formation indices. Low cytokine levels suggest that these factors do not mediate the increased bone resorption of AN.
    Journal of Pediatrics 07/2002; 141(1):64-70. · 4.04 Impact Factor

Publication Stats

877 Citations
109.56 Total Impact Points

Institutions

  • 1996–2013
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 1998–2011
    • Boston Children's Hospital
      • Division of Adolescent Medicine
      Boston, Massachusetts, United States
  • 2009
    • Nationwide Children's Hospital
      Columbus, Ohio, United States
  • 2002–2003
    • Cincinnati Children's Hospital Medical Center
      • Division of Adolescent Medicine
      Cincinnati, OH, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2001
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States