Birth Order Research Articles

Penerapan Fuzzy C-Means dalam Sistem Pendukung Keputusan untuk Penentuan Penerima Beasiswa Program Indonesia Pintar (PIP)

The process of selecting students for educational assistance in schools is still frequently performed manually by comparing individual student data. This approach is time-consuming and vulnerable to subjectivity and human error. To address this issue, this study developed a Decision Support System (DSS) using the Fuzzy C-Means (FCM) algorithm to cluster students based on their eligibility level for aid. FCM is chosen due to its capability to categorize data into multiple clusters based on data similarity. Seven evaluation criteria were employed: father's income, mother's income, father's education, mother's education, birth order, number of siblings, and type of transportation to school. The dataset consists of student information that was preprocessed and weighted based on a predefined scale. Clustering was conducted with a maximum iteration of 100 and an error tolerance of 0.00001. The results indicate that FCM successfully grouped the students into two clusters, with 487 students classified as eligible for assistance and 202 students as ineligible. To validate the clustering, the results were compared with the official Dapodik dataset, which demonstrated a high degree of consistency. Therefore, the implementation of FCM in this decision support system has proven to be effective in producing objective, accurate, and efficient classifications.

Joint Developmental Trajectories of Social Assertiveness and Prosociality: A Parallel Process Latent Class Growth Analysis.

Social assertiveness and prosociality are two related but distinct aspects of social competence that are important to youth's social success. They are likely co-occurrence and interact dynamically over time, but their interdependence and interaction have been overlooked in previous research. This study examined the joint developmental trajectories of the two aspects from middle childhood to early adolescence and tested their associations with aggression, shyness, academic performance and depressive symptoms. Participants included a sample of elementary school children in China (initially N = 1012, 51.2% girls, initial Mage = 9.49 years). Data were collected each year for 4 consecutive years from self-reports and peer nominations. The parallel-process latent class growth model identified three balanced and two imbalanced trajectories: (1) low-stable assertiveness and low-increasing prosociality, (2) both moderate-stable, (3) both high-stable, (4) low-stable assertiveness and high-increasing prosociality, and (5) high-increasing assertiveness and high-decreasing prosociality. In addition, academic performance was a promoting factor whereas the depressive symptom was a weakening factor for the co-developmental trajectories; shyness was positively associated with the two imbalanced developmental groups; aggression was positively associated with the assertiveness-predominant group and negatively associated with the prosociality-predominant group. These findings reveal the heterogeneity of the co-developmental patterns of assertiveness and prosociality and underline the necessity for tailored optimal interventions of social competence according to the diverse characteristics of children.

Ischiopubic synchondrosis osteomyelitis: a rare presentation of a limping child presenting to a paediatric emergency department.

We present a case of a middle childhood boy who presented to our paediatric emergency department with severe right upper thigh pain, radiating to inguinal/hip area. The pain was sharp in nature, described like a severe cramp which started 10 hours prior to presentation, progressively increasing over time. He denied any recent trauma or infective symptoms, and there were no other associated complaints. On physical examination, he was in tears due to excruciating pain which he could not locate precisely, had tense muscles at the right posterior upper thigh and lower gluteal area and had limping. Also, he had mild right testicular tenderness on examination which he did not complain of before, no skin changes or swelling with normal cremasteric reflex. His investigations were significant for asymmetric ischiopubic synchondrosis on pelvic X-ray. Scrotal ultrasound showed no evidence of testicular torsion. Pelvic MRI showed features consistent with the right ischiopubic synchondrosis osteomyelitis. He spiked a high-grade fever of 40°C within 24 hours of presentation. His blood culture grew methicillin-sensitive Staphylococcus aureus On admission, he was managed initially with ceftriaxone, vancomycin and clindamycin. After the blood culture result, he received ceftriaxone for 2 weeks, followed by oral cefuroxime for another 2 weeks. Pain controlled with ketorolac and paracetamol. Our patient was diagnosed and started on antibiotics within 24 hours from presentation.

The Comprehensive Assessment of Theory of Mind (CAT): A Novel Measure of 3- to 8-Year-Old Children's Theory of Mind and an Evaluation of Mental-State Scaling.

This study describes a novel measure of children's Theory of Mind (ToM) development-called the Comprehensive Assessment of ToM (CAT)-that addresses limitations in existing ToM measures. This behavioral measure includes three-six items each about diverse desires, diverse beliefs, knowledge access, knowledge expertise, false belief, and visual perspective taking, as well as nonsocial representational reasoning (i.e., false-sign). All items include a prediction, explanation, and general comprehension question. The measure is psychometrically valid and robust in 3- to 8-year-old children (n = 206; 104 boys; 101 girls; 1 gender fluid; 37.7% White non-Hispanic). Children's performance replicates prior findings with the commonly used Wellman and Liu (2004) ToM scale, but also reveals a novel and nuanced pattern of mental-state scaling over early to middle childhood.

Analyzing High-risk Fertility Behaviors among the Women of Childbearing Age in Bangladesh

High-risk-fertility behavior (HRFB) including excessively young or advanced maternal age, narrower birth interval, adhering to higher birth orders, and experiencing an elevated number of live births to a woman often leads to adverse maternal and child health outcomes. The Bangladesh Demographic and Health Survey (BDHS) data was employed to pinpoint the factors motivating high-risk fertility behaviors in women of childbearing age. Pearson’s chi-square test was employed to conduct the unadjusted bivariate association and binary logistic regression model had been implemented to observe the adjusted association between covariates and HRFB. Overall, approximately one-third (31.9%) of women of childbearing age showed risky fertility behaviors. Women’s education, working status, decision-making autonomy, place of residence, husband’s education, husband’s age, media exposure, and violence against women were significant predictors of maternal HRFB. The escalating prevalence of HRFB in Bangladesh is a cause for concern. Policymakers should prioritize initiatives such as enhancing parental education, fostering women's autonomy, and implementing knowledge- based healthcare interventions for women. These measures aim to mitigate risky fertility behaviors and contribute to improved reproductive health outcomes. Dhaka Univ. J. Sci. 73(2): 127-134, 2025 (July)

Preliminary observations on the influence of maternal pregnancy factors and birth factors on pediatric astigmatism

Objective: To investigate the impact of maternal factors during pregnancy and birth factors on astigmatism in children. Methods: It was a case-control study. Patients aged 3 to 12 years old were continuously selected from October 2023 to January 2024 in the Pediatric Eye Care Department of Qinhuangdao Maternal and Child Health Care Hospital. Children with astigmatism were included as the case group, and children without astigmatism were included as the control group. All children underwent cycloplegic autorefraction. Astigmatism was defined as a cylinder refractive error with an absolute value of≥1.00 diopter. Only the right eye were included in the analysis. The maternal factors during pregnancy [maternal age at delivery, delivery mode, paternal age, progesterone during pregnancy, pre-pregnancy body mass index (BMI), gestational weight gain, smoking during pregnancy, hypertensive disorders of pregnancy, gestational diabetes mellitus] and children's birth history [birth weight, birth order, BMI, preterm birth, nuchal cord] were recorded. The independent t-test, non-parametric test, and Chi-square test were used for comparison between groups. Multiple logistic regression analysis was performed and risk factors during pregnancy for astigmatism in children were identified by calculating the odds ratio (OR) and its 95% confidence interval (95%CI). Results: A total of 146 children (146 eyes) were included in the case group, consisting of 73 males and 73 females with a median age of 6 (5, 9) years, and 161 children (161 eyes) were included in the control group, consisting of 73 males and 88 females with a median age of 7 (5, 9) years. No statistically significant differences in age and gender were found between the two groups (all P>0.05). Multiple logistic regression analysis, with adjustment for confounding factors, showed that the maternal pre-pregnancy BMI 24.0 to <28.0 kg/m2 (OR=2.79, 95% CI: 1.46 to 5.35, P=0.002) or ≥28.0 kg/m2 (OR=3.97, 95% CI: 1.19 to 13.21, P=0.024), birth weight <2.5 kg (OR=5.44, 95% CI: 1.10 to 26.88, P=0.038), and birth order ≥ 2 (OR=2.06, 95% CI: 1.16 to 3.66, P=0.013) were risk factors of astigmatism in children. Conclusions: Higher maternal pre-pregnancy weight, lower birth weight, and non-firstborn status were associated with pediatric astigmatism.

3-methylcrotonyl-CoA carboxylase deficiency in a child with developmental regression and delay: call for early diagnosis and multidisciplinary approach.

3-methylcrotonyl-CoA carboxylase (3-MCC) deficiency (3-MCC-D) is an autosomal recessive disorder with a variable phenotype. Reduced 3-MCC enzyme activity results in impaired leucine metabolism causing, for example, metabolic acidosis, ketotic hypoglycaemia and carnitine deficiency. The spectrum of clinical presentation is wide, ranging from severe early-onset presentations to incidental findings in asymptomatic individuals. This report describes the case of a young girl who underwent dramatic developmental regression at 11 months of age, following a respiratory tract infection. Metabolic investigations revealed high excretions of urinary 3-methylcrotonylglycine and 3-hydroxyisovaleric acid, consistent with 3-MCC-D. Treatment was commenced immediately, including carnitine, biotin and moderate dietetic modifications. Molecular genetic investigations confirmed compound heterozygosity for two pathogenic variants in the MCCC1 gene, Trp358Cysfs*13 and duplication of exons 2 and 3. Now in middle childhood, the girl is meeting all her developmental milestones and has had no metabolic decompensation in 6 years of follow-up.

Striving for Perfect Grades, Delaying Delivery: Exploring Multidimensional Perfectionism and Academic Procrastination

The current research aimed to investigate the association between multidimensional perfectionism and academic procrastination among college and university students, while also exploring the influence of selected demographic variables, including birth order, educational level (college vs. university), and Grade Point Average (GPA). The sample consisted of 300 students, equally divided between college (n = 150) and university (n = 150) institutions. Data were collected using two validated instruments: the Multidimensional Perfectionism Scale (Hewitt &amp; Flett, 1991) and the Tuckman Procrastination Scale (Tuckman, 1991). Correlational analyses demonstrated a substantial association between academic procrastination and various dimensions of perfectionism. Independent samples t-tests indicated that university students were more highly procrastinators than college students. Last-born students exhibited higher levels of procrastination students compared to other birth orders, while first-born students reported higher levels of perfectionism. Students with lower GPAs tended to procrastinate more than average competent and high GPAs students. These results illustrate the intricate relationship among perfectionism, procrastination, and demographics in the academic setting.

Children adjust behavior in novel social environment to reflect local prosocial norms inferred from brief exposure

Stark cultural variation in prosocial behavior, as elicited with economic experiments, is evident despite the high mobility of humans. Conformity to local norms has been posited to play an integral role in the maintenance of this variation. Experiments suggest that adults indeed rapidly infer pro- and antisocial norms in new or altered social environments and adjust their behavior to reflect the inferred norms. Studies of the ontogeny of prosocial behavior show that by middle childhood, children’s prosocial behavior conforms to that of local adults. Furthermore, by this stage, children are susceptible to the manipulation of explicit normative information. However, their propensity to extract or infer normative information from the environment and change their behavior accordingly has not been investigated. Here, we assess whether children 1) rapidly infer local prosocial norms in a novel, realistic social environment, 2) extend these inferences to norms for unobserved behaviors, and 3) alter their behavior in the novel environment to align with the inferred norms while still 4) maintaining their baseline prosocial behavior outside of the novel environment. We used questionnaires to measure children’s perceived pro- and antisocial descriptive norms in their Own Neighborhoods as well as in a novel “Neighborhood X,” to which they were introduced via a slideshow. Norms for Neighborhood X diverged drastically dependent upon which slideshow they witnessed (Prosocial or Antisocial condition), a result robust to the exclusion of questions about norms for behaviors observed in the slideshow. Children’s perceptions of prosocial norms in their Own Neighborhoods predicted their prosocial behavior (Dictator Game) in their Own Neighborhood. Moreover, even though information about giving behavior was not presented in the slideshow, inferred norms for Neighborhood X predicted children’s prosocial behavior in that neighborhood as well. These changes in prosocial behavior were transitory and specific to Neighborhood X; prosocial behavior in a separate “Helping Task” was best predicted by prosocial norms within the children’s Own Neighborhoods. Our results are consistent with the hypothesis that humans have a propensity to rapidly infer and conform to local prosocial norms, thus maintaining group differences in prosocial behavior, and further indicate that this propensity is in operation by middle childhood.

Socioeconomic Determinants of Childhood Obesity in India: An Empirical Study Using NFHS-5

Introduction: Good health is considered the most important wealth a human can have. But nowadays, due to the transitional changes in the economy, changing job roles, and food habits, the majority of the world's population is leaning towards an idle, sedentary lifestyle. Obesity is a health condition characterized by excessive accumulation of fat, especially in the lower abdomen area, with respect to the specific age and gender of an individual. Objective: The current study aims to find socioeconomic correlates of childhood obesity in India. Data: This study uses data from the 5th cycle National Family Health Survey (2019-2021) conducted by the Ministry of Health and Family Welfare (MoHFW). For analysis, ‘Children Recode File’ (IAKR7EFL) is utilized in STATA format. After omitting the missing entries from every variable used in the model, a total of 582 children are considered for obesity analysis. Methods: Ordered Logit Regression is run, accounting for three categories of obesity: non-obese, mildly obese, and severely obese. Odds ratios are estimated to check the probability of the occurrence of childhood obesity. Marginal effects are then calculated to get the incidence of category-specific obesity. Result and Discussion: Haemoglobin level of mothers has a slightly unfavourable effect on obesity, the marginal effect of that variable is positive in the non-obese category but is negative in mild obesity and severe obesity. Both Hindu and Muslim households have unfavourable but significant effects on obesity. Receiving PNC turns out to be an unfavorable variable in occurring obesity. Moving from medium birth order to low birth order decreases the possibility of obesity. Both very low and medium birth intervals cause the incidence of childhood obesity. Proper and sufficient breastfeeding can cut down the probability of obesity in children. Lastly, low antenatal care accounts for a lower possibility of children being obese. Thus, the reasonable and permissible effort from the public authority for such controllable causes can be the way forward towards the reduction of obesity in the future generation of the country.

Why Motor Competence Matters: Fundamental Movement Skills and Their Role in Promoting Physical Activity and Health in Czech Children Aged 9–10 Years

Background: Motor competence (MC) plays a critical role in shaping children’s physical activity, health-related fitness, and weight status. However, few studies have explored these interrelationships during middle childhood. Objectives: The current study aimed to examine the relationships between MC and physical activity (PA), health-related fitness (HRF), and weight status (WS) in children during middle childhood (9–10 years). Simultaneously, the study aimed to find possible differences in PA, HRF, and WS between children with different levels of MC. Methods: In this cross-sectional study, the TGMD-2 (MC), UNIFITTEST 6–60 (HRF), ActiGraph GT3X (PA), and anthropometry (WS) were administered to 86 children (59 boys, age range of 9–10 years and mean age of 10.1 ± 0.6 years). Results: A significant strong association was observed between MC and HRF (p &lt; 0.01, Cramer‘s V = 0.42). Significant moderate associations were observed between MC and WS (p &lt; 0.05, Cramer’s V = 0.34) and between MC and PA (p &lt; 0.05, Cramer‘s V = 0.25). Children with high MC proficiency demonstrated significantly higher levels of HRF (p &lt; 0.01; large ES) and PA (p &lt; 0.05; moderate ES) and a healthier WS (p &lt; 0.01; moderate ES) than those with low MC proficiency. Similarly, children with moderate MC proficiency outperformed children with low MC in terms of HRF and WS. Conclusions: The strong associations between MC and key health indicators such as PA, HRF, and WS suggest that movement proficiency in middle childhood should be viewed as a cornerstone of health promotion. Although no causal claims can be made, the results emphasize the practical importance of integrating targeted motor skill development—especially FMSs—into school-based physical education and extracurricular programs. Supporting MC at this age may be a decisive step toward fostering long-term engagement in physical activity and improving children’s overall health trajectories.

Child admitted with a scrotal haematoma, discharged with coarctation of the aorta.

A male child in middle childhood (6-11 years) was admitted to the paediatric ward under the care of the surgical team following a scrotal injury sustained during a football game 4 days earlier. His blood pressure (BP) was noted to be elevated during his admission, which triggered reviews and further investigations. It was initially felt that the pain, due to a scrotal haematoma, was the cause of his hypertension. However, the continued vigilance and persistence of the nursing staff led to a further opinion being sought. This led to the clinical suspicion and later confirmed diagnosis of coarctation of the aorta.

Indocyanine green fluorescence imaging in the identification of sentinel lymph node in melanoma.

Sentinel lymph node biopsy is imperative in the management of melanoma and allows for accurate histological assessment of nodal basins in stage 1B disease, or greater. Indocyanine green (ICG) represents a somewhat novel localisation modality that may confer a decreased risk of anaphylaxis and reduced risk of skin discolouration. A middle childhood (6-11 years) boy with a 3-month history of a new, pigmented, right cheek lesion was referred for evaluation. Excisional biopsy revealed a pigmented epithelioid melanocytoma.After the MDM discussion, a WLE and sentinel lymph node biopsy were recommended. The sentinel node was successfully identified using intraoperative ICG fluorescence imaging. There were no adverse outcomes such as skin staining or lack of dye uptake.Although initially positive for nodal micrometastases, management consisted of clinical follow-up with 3 monthly ultrasound scans of the neck. To date, there is no evidence of recurrence.

From childhood to adolescence: Development of binge eating and the prospective role of self-regulation

BackgroundResearch shows that binge eating often starts in childhood or adolescence, but its development remains largely unexplored. Additionally, while cross-sectional studies link self-regulation to binge eating, longitudinal research is lacking. Therefore, this study examined the development of binge eating and self-regulation as a potential predictor for this development in a community sample.MethodsA total of N = 1660 children were assessed at four time points spanning ages 6–11, 7–11, 9–13, and 16–21. The assessment of self-regulation encompassed emotional reactivity, working memory updating, cognitive flexibility, inhibition, inhibitory control, planning behavior, affective decision-making, anger regulation, and as appetite self-regulation, satiety responsiveness, emotional overeating, food responsiveness, and external eating, using computerized tasks, teacher- and parent-reports. Binge eating was modeled by child-reported loss of control eating, overeating, and eating in the absence of hunger. A latent change score model was used to evaluate intra- and interindividual differences in binge eating across middle childhood and adolescence. Self-regulation facets were regressed on changes in binge eating.ResultsResults indicated a decrease in binge eating at the beginning of middle childhood, followed by a stagnation and then an increase during adolescence, with significant interindividual differences in these changes. Higher planning behavior, inhibitory control, and cognitive flexibility predicted decreases in binge eating during middle childhood, while higher satiety responsiveness unexpectedly predicted an increase in binge eating during adolescence. Results remained the same after controlling for body weight.ConclusionsOur findings highlight adolescence as a critical period for binge eating prevention, with planning behavior, inhibitory control, and cognitive flexibility acting as protective factors in middle childhood. The longitudinal data underscore the importance of self-regulation in the development of binge eating.

Maternal Characteristics and Home Environment as Early Childhood Predictors of Elementary School Children’s Executive Functions in Chile

SYNOPSIS Objective. We do not know which maternal characteristics and aspects of the home environment are associated with more favorable executive function (EF) development in understudied Global South populations. The current study attempts to address this research gap. Design. A sample of 4,464 mother—child dyads was followed over 8 years. Maternal personality and cognitive abilities were assessed at child age 2.7 years, parental emotional support and the home learning environment at child age 4.8 years, and maternal parenting stress and children’s verbal working memory (Backwards Digit Span), and global EFs (Hearts and Flowers tasks) at child age 10.5 years. Generalized linear model analyses were conducted to examine whether maternal characteristics and the home environment during early childhood predicted verbal working memory and global EFs in middle childhood, after controlling for sociodemographic family characteristics. Results. Maternal attention and working memory, maternal vocabulary, and the home learning environment were positively associated with children’s verbal working memory, whereas maternal parenting stress was negatively associated with children’s verbal working memory. Maternal attention and memory, as well as parental emotional support, showed positive associations, whereas maternal neuroticism, the home learning environment, and maternal parenting stress showed negative associations with children’s global EFs. Conclusions. Maternal characteristics and the home environment during early childhood play specific roles in children’s EF skills across middle childhood in Chilean elementary school children in ways that might guide researchers, practitioners, and policymakers in designing prevention or intervention programs.

Metamotivational Beliefs in Middle Childhood: Evaluating Children's Understanding of Task‐Motivation Fit

ABSTRACTSelf‐regulation—the monitoring and control of thoughts, feelings, and behavior—plays a central role in guiding healthy social development. While the bulk of the literature examining children's self‐regulation has focused on how much or how well children can regulate specific cognitive functions or behaviors (e.g., emotion control, delay of gratification), recent adult research demonstrates the role of metamotivation—the monitoring and control of motivational states—in self‐regulation. Metamotivation is guided by metamotivational beliefs, including beliefs about which motivational state best fits the task at hand (beliefs about task‐motivation fit). Research with adults demonstrates that having normatively accurate beliefs about task‐motivation fit supports both individual achievement and social/occupational success. However, research has yet to investigate children's metamotivational beliefs. The current research addresses this gap by assessing children's beliefs about task‐motivation fit. In Study 1, participants in middle childhood (N = 66; Mage = 7.7 years) rated how well they would expect to perform on expansive‐eager tasks (tasks optimally performed with eagerness or expansion) and contractive‐vigilant tasks (tasks optimally performed with vigilance or contraction) with eagerness (vs. vigilance) and expansion (vs. contraction). Study 2 was a direct replication of Study 1 with adult participants (N = 210; Mage = 39.3 years). Across both studies, participants had a general preference for vigilance over eagerness. While both children and adults reported some normatively accurate metamotivational beliefs about task‐motivation fit, adults demonstrated these normatively accurate beliefs to a greater extent. These findings are discussed in terms of the importance of incorporating metamotivational beliefs into developmental models of self‐regulation with the goal of supporting positive socialization and social developmental outcomes.

Dengue cerebellitis in middle childhood from South India.

We had a girl in middle childhood, who presented with fever of 7 days duration, vomiting, abdominal pain, headache, myalgia and arthralgia. The child was conscious with signs of shock. With the provisional diagnosis of dengue fever, enteric fever or scrub typhus, the child was given all supportive management. Lab investigations covering the fever panel were sent. Within 24 hours of admission, the child developed horizontal nystagmus, diplopia and intermittent dizziness. Fundus examination showed papilloedema. MRI brain showed hyperintensity of the cerebellum in T2 sections suggestive of cerebellitis. Dengue IgM antibody was positive with transaminitis and hyperferritinaemia. Child was given anti-oedema measures with supportive care. The patient recovered on day 10 of illness, and cerebellar signs subsided. Though dengue fever is commonly seen in tropical countries, the atypical presentation in the form of cerebellitis is found to be rare. The timely diagnosis helped in rapid recovery from this neurological manifestation.

Examining the unfair concentration of non-institutional deliveries among poor households in India: a study of predictors and wealth-based inequality

BackgroundNon-institutional deliveries, defined as childbirth outside healthcare facilities, remain a significant global concern. It poses serious maternal and child health problems and significantly contributes to maternal and infant mortality. India witnessed a sustained decrease in non-institutional deliveries in thepast 20 years. However, the rate of decline has tapered recently while the country still has a sizeable number of women delivering out of the facility. To better understand the enduring proportions of non-institutional deliveries, this study preliminarily analyses its predictors. The prime objective of the study is to unravel the inequality in the prevalence of non-institutional deliveries and understand if they are unfairly concentrated among certain households in India. It also aims to provide policy-relevant insights into the socioeconomic factors contributing to its concentration among specific households and their implications for maternal and child health.MethodologyUsing the National Family Health Survey-5 (NFHS-5) data (N = 1,75,569 deliveries), we developed a regression model to understand the existing non-institutional deliveries and their predictors. We employed the Erreygers’ Concentration Index (ECI) to quantify the degree of concentration (inequality) of non-institutional deliveries among households. Furthermore, a decomposition analysis was run to analyse the factors contributing to the concentration of non-institutional deliveries in a particular groups of households. It breaks down the overall inequality at population level into its constituent parts to identify the sources of inequality. This approach helps discover prime causes of inequality, such as differences in income, education, or other relevant factors.FindingsOut of the total sampled deliveries in the reference period, around 14% were non-institutional. Inequality analysis (ECI=-0.2174; p-value < 0.0001) suggests that non-institutional deliveries were unequally and unfairly concentrated in low-income households. The concentration of non-institutional deliveries in poor households was majorly contributed by factors like education (13.85%), wealth (13.91%), mass media exposure (12.27%) region (9.76%), birth order (3.17%), distance to health facilities (2.77%), caste (2.82%), timing of first ANC visit (1.07%), and women considering having to take transport as a problem (1.60%).ConclusionsThis research employs inequality analyses of non-institutional deliveries and contributes to the existing literature by establishing its unfair concentration among poor households in India. It expands our understanding of the factors driving non-institutional deliveries among the disadvantaged. The findings highlight the importance of targeted interventions and policies to reduce the concentration of last-mile non-institutional deliveries among vulnerable women living in marginalized households.

A clinical case of familial alopecia areata in combination with immune pathology

Alopecia areata (AA) is a chronic inflammatory disease that causes partial or complete hair loss and is based on autoimmune processes. Current studies are actively investigating the use of JAK inhibitors for AA treatment, but data on the safety and efficacy of these drugs in patients with congenital immunodeficiency are practically non-existent. A unique clinical case of familial form of severe AA in two sisters with congenital immune disorders, that caused certain difficulties in treatment, is presented. The older sister, 24 years old, has been diagnosed with primary immunodeficiency — selective IgA deficiency combined with IgG2 deficiency, and the younger sister, 18 years old, is under observation with suspicion of immunodeficiency with a predominant defect of antibodies. Both patients receive targeted therapy with tofacitinib, in presence of which a partial hair regeneration, more pronounced in the younger sister, has been noted. This clinical case emphasizes the need for multidisciplinary interaction of dermatologists, immunologists and geneticists in treating patients with AA and congenital immune disorders. Special attention should be paid to clinical and laboratory monitoring to minimize the risk of infections associated with therapy using JAK inhibitors. Our observation contributes to the understanding of genetic and immune mechanisms of AA and confirms the possibility of JAK inhibitors application in patients with autoimmune diseases affected by immunodeficiency. These data may serve as an addition to the development of new recommendations and treatment algorithms in such cases, and still the final efficacy and safety of such therapy require further study.

Exploring Factors Influencing Students’ Affective Engagement with Systems Thinking

Increasing complexity in today’s world requires skills to analyze ideas, identify connections, and view concepts holistically. Systems thinking addresses this need by focusing on the interactions and relationships among various elements. However, developing this skill requires explicit and scaffolded activities for effective learning. To explore how this can be achieved, a descriptive survey was conducted to determine whether significant differences exist in students' affective learning of systems thinking based on gender, academic grade, and birth order. These factors were examined as they relate to emotional responses, engagement, and motivation, which are critical to developing students’ ability to apply systems thinking effectively. The study involved 380 junior high school students from a public high school in the Philippines. Findings revealed significant differences in how male and female students applied systems thinking. Students with higher academic grades showed greater appreciation for its application, while birth order had minimal influence on perspectives regarding systems thinking capabilities. These findings highlight the importance of strategies that consider individual differences, such as gender-related variations and cognitive diversity, in enhancing systems thinking development. By incorporating these insights, educators can design targeted interventions, and researchers can develop strategies to foster systems thinking skills essential for addressing real-world challenges.