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Kelly J Kelleher

Publications and source records attributed to Kelly J Kelleher.

At least 19 recordsLinked to original sources
PubMed2026

BIOCARD framework: integrating fecal bile acids, lipids, and metabolites to assess response to a cardiovascular health intervention.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality, particularly in under-resourced populations. Although nutritional interventions are important for CVD prevention, their outcomes are commonly evaluated using conventional clinical and behavioral indicators, which may not fully capture early molecular responses. In this study, we developed the BIOCARD framework, an exploratory fecal multi-omics platform integrating bile acids, lipids, and metabolites to evaluate intervention outcomes related to cardiovascular health. Fecal samples were collected from caregiver-child participants enrolled in a 10-week randomized controlled trial comparing a multicomponent garden-based intervention (SHA) with an education-only control group (MSP). Fecal polar metabolites, lipids, and bile acids were analyzed by UHPLC-HRMS-based approaches and integrated with conventional health indicators. Traditional clinical indicators in the present study showed limited sensitivity for detecting intervention-related differences. In contrast, fecal multi-omics analyzes revealed intervention-associated differences in metabolites, lipids, and bile acids, with children showing more apparent molecular variation than parents. Network analysis further revealed associations between selected molecular features and cardiovascular-related indicators, including blood pressure, body fat, skin carotenoids, and Healthy Eating Index scores. Together, these findings suggest that the BIOCARD framework may serve as an exploratory molecular approach to complement traditional outcome measures and improve the evaluation of nutritional interventions for cardiovascular health.

Humans↗
PubMed2007

Barriers to the identification and management of psychosocial issues in children and maternal depression.

CONTEXT: Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians. OBJECTIVES: The purpose of this work was to determine whether (1) perceived barriers to care for children's psychosocial issues and maternal depression aggregate into patient, physician, and organizational domains, (2) barrier domains are distinct for mothers and children, and (3) physician, patient, and practice/organizational characteristics are associated with different barrier domains for children and mothers. METHODS: We conducted a cross-sectional survey of the 50,818 US nonretired members of the American Academy of Pediatrics. Of a random sample of 1600 members, 832 (745 nontrainee members) responded. This was a mailed 8-page survey with no patients and no intervention. We measured physician assessment of barriers to providing psychosocial care for children's psychosocial problems and maternal depression. RESULTS: Pediatricians frequently endorse the lack of time to treat mental health problems (77.0%) and long waiting periods to see mental health providers (74.0%) as the most important barriers to the identification and treatment of children's psychosocial problems. For maternal depression, pediatricians most often endorsed lack of training in treatment (74.5%) and lack of time to treat (64.3%) as important barriers. Pediatricians' reports of barriers clustered into physician and organizational domains. Physician domains were distinct for children and mothers, but organizational domains were not. Several physician and practice characteristics are significantly associated with the 4 barrier scales, and different characteristics (eg, sociodemographic, attitudinal, and practice features) were related to each barrier area. CONCLUSIONS: Pediatricians endorse a wide range of barriers with respect to the diagnosis and treatment of children's mental health problems and maternal depression. The specificity of factors relating to various barrier areas suggests that overcoming barriers to the identification and treatment of child mental health problems and maternal depression in primary care pediatrics is likely to require a multifaceted approach that spans organizational, physician, and patient issues. In addition, comprehensive interventions will likely require social marketing approaches designed to engage diverse audiences of clinicians and their patients to participate.

Child↗
PubMed2006

Admission to acute care hospitals for adolescent substance abuse: a national descriptive analysis.

BACKGROUND: Use of alcohol and illicit drugs by adolescents remains a problem in the U.S. Case identification and early treatment can occur within a broad variety of healthcare and non-healthcare settings, including acute care hospitals. The objective of this study is to describe the extent and nature of adolescent admissions to the acute inpatient setting for substance abuse (SA). We use the Agency for Healthcare Research and Quality (AHRQ) 2000 Healthcare Cost and Utilization Project Kids Inpatient Database (HCUP-KID) which includes over 2.5 million admissions for youth age 20 and under to 2,784 hospitals in 27 states in the year 2000. Specifically, this analysis estimates national number of admissions, mean total charges, and mean lengths of stay for adolescents between the ages of 12 and 17 admitted to an acute care hospital for the following diagnostic categories from the AHRQ's Clinical Classifications Software categories: "alcohol-related mental disorders" and "substance-related mental disorders". Frequency and percentage of total admissions were calculated for demographic variables of age, gender and income and for hospital characteristic variables of urban/rural designation and children's hospital designation. RESULTS: SA admissions represented 1.25 percent of adolescent admissions to acute care hospitals. Nearly 90 percent of the admission occurred in non-Children's hospitals. Most were for drug dependence (38%) or non-dependent use of alcohol or drugs (35%). Costs were highest for drug dependence admissions. Nearly half of admissions had comorbid mental health diagnoses. Higher rates of admission were seen in boys, in older adolescents, and in "self-pay" patients. Alcohol and drug rehabilitation/detoxification, alone or in combination with psychological and psychiatric evaluation and therapy, was documented for 38 percent of admissions. Over 50 percent of cases had no documentation of treatment specific to substance use behavior. CONCLUSION: General acute care hospitals have a significant and important opportunity to recognize, treat, and refer adolescents with substance abuse problems. These results suggest that inpatient facilities should develop and implement policies and processes to ensure that adolescent substance abusers admitted to their institutions receive appropriate care during the admission and appropriate referral to community care resources.

Adolescent↗
PubMed2006

Perceived barriers to treatment and psychotherapy attendance in child community mental health centers.

Poor psychotherapy attendance is a major problem facing most child community mental health centers. However, post-treatment perspectives on reasons for premature termination are rarely sought from either families or clinicians. In the present study, we collected parent data and clinician data regarding 72 and 153 clients, respectively, from four child and adolescent community mental health centers serving diverse families. Problems regarding (a) the perceived relevance of treatment and (b) the quality of the therapist-family relationship emerged as the two most consistent factors related to premature dropout. Possible interventions to increase psychotherapy attendance are highlighted.

Adolescent↗
PubMed2006

The role of care location in diagnosis and treatment of pediatric psychosocial conditions.

Racial differences in diagnosis and treatment of psychosocial conditions have been well documented. It is unclear if these differences represent variance in prevalence or are actually disparities in care driven by social factors, income-related differences, or differences in the actual location of care. We used 4 years of National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys as source for data on visits to private offices and hospital-based clinics. In addition to the standard practice of combining surveys across years, we used a "supersurvey" approach to combining the 2 distinct surveys. In our roughly 20,000 sampled visits, we confirmed the higher concentration of low-income children in visits to hospital-based clinics (p <.001), but saw no significant racial difference (p =.104). After controlling for race, income, and other demographics, we found that visits to hospital-based clinics were significantly more likely to include a diagnosis of depression (odds ratio [OR], 4.4; p =.011), but that there was no statistically significant difference in other psychosocial diagnoses. Once a diagnosis is made, there is no evidence of differences in treatment or follow-up between office-based or hospital clinic-based providers. Our analyses support previously gathered evidence for differences in economic status of the clientele of private offices and hospital-based clinics. We surprisingly found visits to clinics to be more likely to include a depression diagnosis, but this may be an artifact of the data reflecting visits rather than patients. We found no evidence that treatment or follow-up is different for the disadvantaged who use clinics rather than private offices.

Adolescent↗
PubMed2006

Management of pediatric mental disorders in primary care: where are we now and where are we going?

PURPOSE OF REVIEW: Pediatric mental disorders are among the most common disorders of childhood and are routinely seen in primary care. We review innovative management strategies, treatment technologies, and models of collaboration with behavioral health specialists in general medical settings. Our goal is to advance the integration of behavioral health services into primary care. RECENT FINDINGS: The application of mental health interventions with proven efficacy holds great promise for youths with mental disorders. Unfortunately, traditional primary-care management of pediatric mental disorders is characterized by nonspecific counseling, low-dose prescribing, and referrals to specialty settings that are often not completed. SUMMARY: The development, study, and refinement of new assessment and treatment technologies, supplemental treatments, and collaborative models of care delivery will be necessary to ensure more effective care for youths with mental disorders and their families. The promise of pediatric mental healthcare will not be fulfilled unless primary-care clinicians and behavioral health specialists forge new collaborative relationships that enhance the delivery of evidence-based care to affected children and their families.

Adolescent↗
PubMed2006

Persistence of intimate partner violence among families referred to child welfare.

The purpose of this study is to examine the longitudinal course of intimate partner violence (IPV) among female caregivers of children receiving child welfare services. Data are derived from the National Survey of Child and Adolescent Well-Being, a national probability study of children investigated for child abuse and neglect in the United States. Caregivers (n = 861) are interviewed about demographic characteristics, mental health, substance use, and physical violence by a partner at the close of the investigation and at an 18-month follow-up. Polychotomous logistic regression examines the associations of severe and minor IPV controlling for caregiver and environmental characteristics. The results suggest that factors related to initial risk for IPV do not affect the continuation of IPV and that patterns of IPV differ for racial and ethnic groups.

Adolescent↗
PubMed2006

Female caregivers' experiences with intimate partner violence and behavior problems in children investigated as victims of maltreatment.

OBJECTIVE: We examined the relationship between women's experiences with intimate partner violence and their reports of child behavior problems. METHODS: Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children who were the subjects of child abuse and neglect investigations. The sample consisted of 2020 female caregivers of children between the ages of 4 and 14 years who were interviewed about demographic characteristics, child behavior problems, female caregiver mental health, parenting behaviors, experiences with intimate partner violence, and community characteristics. Information on child abuse and neglect was obtained in interviews with child protective services workers. Multiple-regression analyses were used to investigate the association between caregiver victimization and child behavior problems while controlling for the effects of child, family, and environmental characteristics. The potential moderating effects of caregiver depression and parenting practices on the relation between intimate partner violence and child behavior problems were examined also. RESULTS: Severe intimate partner violence was associated with both externalizing and internalizing behavior problems when other risk factors were controlled. Use of corporal punishment and psychological aggression were significant moderators, but maternal depression did not moderate the relation between intimate partner violence and behavior problems. CONCLUSIONS: This study adds to the evidence that maternal caregivers' experiences with intimate partner violence are related to child functioning. The findings suggest that systematic efforts are needed to ensure that mental health needs are identified and addressed appropriately in children exposed to this violence.

Adolescent↗
PubMed2006

Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem?

OBJECTIVE: Significant racial, ethnic, and socioeconomic disparities have been observed in the rates of perforated appendicitis among children, by using large administrative databases. This study evaluated whether these factors had an impact on the care of patients with appendicitis at a major children's hospital with a well-established, comprehensive, primary referral system. METHODS: A retrospective analysis was performed for all children between the ages of 2 and 20 years who were treated for appendicitis between January 1, 2001, and December 31, 2003. Demographic variables included patient age, gender, race, insurance status, parental educational status, and income level. Coding data were used to identify patients with perforated appendicitis. The use of radiologic imaging was also analyzed. RESULTS: During the 3-year period, 788 patients were treated for appendicitis. The racial distribution (white: 81%; black: 12%; other: 7%) was consistent with the demographic composition of the local population. The overall perforation rate was 25%, and the rate was significantly greater in the age group of <6 years, compared with older children. However, there were no significant differences in the perforation rate with respect to race, insurance status, educational level, or income status. Rates of radiologic imaging use were similar among all racial and socioeconomic groups. CONCLUSIONS: Although racial and socioeconomic disparities in the rates of perforated appendicitis among children have been reported, we found no significant evidence for such inequality at our institution. This may reflect improved access, early diagnosis, and referral by primary care physicians in the community. Pooled national and multiple-state administrative databases have been used to highlight persistent disparities in health care. This study illustrates how single-institution data sources can be used to test a local hypothesis generated by national data, with surprisingly different results.

Acute Disease↗
PubMed2005

Medicaid insurance policy for youths involved in the criminal justice system.

Juvenile justice and Medicaid agencies share an interest in serving delinquent youths, many of whom have a relatively poor health status. However, many state and local Medicaid policies result in these youths having no insurance coverage, making access to needed services difficult. A nationally representative survey of state and community juvenile justice and Medicaid agencies was conducted to assess Medicaid policies. Evidence from the survey suggests that in some areas delinquent youths are actively disenrolled from Medicaid benefits, and in others little effort is made to connect them to Medicaid coverage. Discrepancies between justice agency and Medicaid agency responses point to poor communication and coordination. Overall, the survey identified several opportunities for policy intervention to enhance access to services for justice-involved youths.

Adolescent↗
PubMed2005

Informed consent for emergency surgery in infants and children.

The informed consent process for emergency surgery in children poses a challenge for pediatric surgeons because the child and his/her surrogates (usually parents) must make medical decisions in a relatively short period. The unique circumstances of a surgical emergency create potential barriers to achieving the central goals of the informed consent process, respect for patient autonomy and beneficence. The purpose of this review is to provide a practical guide for pediatric surgeons on the informed consent process as it applies to emergency surgery in pediatric patients. We will also discuss innovative methods of preoperative education that can be adopted in the emergency setting and highlight areas in which further research might help to improve this important aspect of surgical care.

Child↗
PubMed2005

Race/ethnicity and insurance status as factors associated with ADHD treatment patterns.

Using data from the 1997-2000 Medical Expenditure Panel Survey (MEPS), disparities in different stages of attention-deficit/hyperactivity disorder (ADHD) health care were investigated, from initial detection to follow-up physician visits and psychotherapy appointments. Differences in ADHD diagnoses, stimulant usage, and health-care visits were examined by age, race/ethnicity, region, and type of insurance. Major significant findings were: (1) children without insurance had lower levels of care in all stages relative to children with insurance, (2) Hispanic-American and African-American children were less likely to be diagnosed with ADHD by parent report than were white American children, and (3) African-American youths with ADHD were less likely to initiate stimulant medication relative to white American children. Implications for expanding childhood health insurance coverage, and for future work on minority mental health care in regard to ADHD, are discussed.

Adolescent↗
PubMed2004

Computerized adaptive measurement of depression: a simulation study.

BACKGROUND: Efficient, accurate instruments for measuring depression are increasingly important in clinical practice. We developed a computerized adaptive version of the Beck Depression Inventory (BDI). We examined its efficiency and its usefulness in identifying Major Depressive Episodes (MDE) and in measuring depression severity. METHODS: Subjects were 744 participants in research studies in which each subject completed both the BDI and the SCID. In addition, 285 patients completed the Hamilton Depression Rating Scale. RESULTS: The adaptive BDI had an AUC as an indicator of a SCID diagnosis of MDE of 88%, equivalent to the full BDI. The adaptive BDI asked fewer questions than the full BDI (5.6 versus 21 items). The adaptive latent depression score correlated r =.92 with the BDI total score and the latent depression score correlated more highly with the Hamilton (r =.74) than the BDI total score did (r =.70). CONCLUSIONS: Adaptive testing for depression may provide greatly increased efficiency without loss of accuracy in identifying MDE or in measuring depression severity.

Adult↗
PubMed2004

Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study.

OBJECTIVE: To document follow-up care received by children identified with attention deficit hyperactivity disorder (ADHD) by primary care clinicians (PCCs). STUDY DESIGN: We surveyed families of children 4 to 15 years of age who had been diagnosed with ADHD. At an index office visit, parents and clinicians completed questionnaires. Six months after the index visit, parents completed a questionnaire (N = 659 returned surveys, 68% return rate). The main outcome measure was the number of visits with the patients' PCCs or mental health specialists during the 6 months after the index visit. RESULTS: Children had a median of one visit PCC over a period of 6 months. Children who had prescriptions for psychotropic medications (78%) did not differ from others in the number of visits. Follow-up visits with the child's own doctor were more common when the PCC had completed mental health training. Only 26% of patients saw a mental health specialist. Children who were black, on Medicaid, or with higher levels of internalizing symptoms were more likely to see a mental health specialist. CONCLUSIONS: Children treated for ADHD need more follow-up visits to permit adjustment of medication and support continuation of patients in treatment. Systematic quality improvement efforts are warranted.

Adolescent↗
PubMed2004

Parent/caregiver satisfaction with their child's Medicaid plan and behavioral health providers.

The experiences of children in FFS and MC managed care plans (n = 715) were examined through satisfaction ratings by their parents/caregivers about their behavioral health provider and their Medicaid behavioral health plan. Multivariate regression analyses compared satisfaction ratings among children enrolled in FFS versus MC while controlling for other known predictors of satisfaction including child and parent/caregiver demographic characteristics, behavioral health status, and child history of behavioral health service use. Caregiver satisfaction with their children's behavioral health provider did not differ significantly between those children in managed care plans and those in fee-for-service plans. However, satisfaction ratings for Medicaid FFS plans were significantly more positive than those for Medicaid MC plans.

Adolescent↗