"Good practices" in pediatric clinical care for disorders/differences of sex development.

PURPOSE: To define, benchmark, and publicize elements of quality care (i.e., "good practices") for pediatric patients with disorders/differences of sex development (DSD). METHODS: Principles of quality care were identified by literature review; consensus exists for 11 good practices and adherence was evaluated through online survey of 21 North American clinical sites. RESULTS: Strong uptake was observed for many practices, particularly specialty participation (n ≥ 17 of 21 sites for most core specialties); point of contact (n = 18); expertise in gender dysphoria/dissatisfaction (n = 20); and DSD-specific continuing medical education (n = 18). Greater variability was apparent for frequency of peer support referrals (n = 12 universally practiced); standardized questionnaires for routine assessment of psychosocial adaptation (n = 13) and gender development (n = 10); consistently clarifying patient/family values in decision-making (n = 15); genital exam protocols that exclude trainee education as primary reason (n = 15); and internal patient-tracking efforts (n = 5-10 of 20 sites). CONCLUSION: This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.

Lifetime segmented assimilation trajectories and health outcomes in Latino and other community residents.

OBJECTIVES: Under an ecodevelopmental framework, we examined lifetime segmented assimilation trajectories (diverging assimilation pathways influenced by prior life conditions) and related them to quality-of-life indicators in a diverse sample of 258 men in the Phoenix, AZ, metropolitan area. METHODS: We used a growth mixture model analysis of lifetime changes in socioeconomic status, and used acculturation to identify distinct lifetime segmented assimilation trajectory groups, which we compared on life satisfaction, exercise, and dietary behaviors. We hypothesized that lifetime assimilation change toward mainstream American culture (upward assimilation) would be associated with favorable health outcomes, and downward assimilation change with unfavorable health outcomes. RESULTS: A growth mixture model latent class analysis identified 4 distinct assimilation trajectory groups. In partial support of the study hypotheses, the extreme upward assimilation trajectory group (the most successful of the assimilation pathways) exhibited the highest life satisfaction and the lowest frequency of unhealthy food consumption. CONCLUSIONS: Upward segmented assimilation is associated in adulthood with certain positive health outcomes. This may be the first study to model upward and downward lifetime segmented assimilation trajectories, and to associate these with life satisfaction, exercise, and dietary behaviors.

A Methodology for Conducting Integrative Mixed Methods Research and Data Analyses.

Mixed methods research has gained visibility within the last few years, although limitations persist regarding the scientific caliber of certain mixed methods research designs and methods. The need exists for rigorous mixed methods designs that integrate various data analytic procedures for a seamless transfer of evidence across qualitative and quantitative modalities. Such designs can offer the strength of confirmatory results drawn from quantitative multivariate analyses, along with "deep structure" explanatory descriptions as drawn from qualitative analyses. This article presents evidence generated from over a decade of pilot research in developing an integrative mixed methods methodology. It presents a conceptual framework and methodological and data analytic procedures for conducting mixed methods research studies, and it also presents illustrative examples from the authors' ongoing integrative mixed methods research studies.