Optimism

Purpose: This study assessed the prevalence of sleep disturbance and associated factors in patients with hepatocellular carcinoma (HCC) receiving hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy and immunotherapy. Patients and Methods: A cross-sectional survey enrolled 230 patients undergoing HAIC combined with targeted therapy and immunotherapy at Sun Yat-sen University Cancer Center (July–November 2025). Sleep, psychological distress, pain, appetite, and quality of life were assessed using the PSQI, HADS, NRS, VAS, and EORTC QLQ-C30, respectively, along with prior HAIC cycles. Logistic regression identified factors associated with sleep disturbance. Results: The prevalence of sleep disturbance (PSQI > 5) was 72.6% (167/230). Univariate analysis identified a greater number of prior HAIC cycles, higher levels of depressive and anxiety symptoms, and lower quality of life and appetite as significant factors. In multivariate analysis, four factors remained independently associated with sleep disturbance: prior HAIC cycles (OR = 1.66, 95% CI: 1.25– 2.20, P < 0.001), anxiety symptoms (OR = 1.27, 95% CI: 1.12– 1.44, P < 0.001), depressive symptoms (OR = 1.23, 95% CI: 1.03– 1.47, P = 0.021), and appetite sensations (OR = 0.93, 95% CI: 0.91– 0.96, P < 0.001), which showed an inverse association with sleep disturbance. The model showed an apparent area under the ROC curve of 0.92 (95% CI 0.87– 0.96), with an optimism-corrected AUC of 0.91 after bootstrap resampling. Conclusion: Sleep disturbance was highly prevalent and was independently associated with cumulative treatment burden, psychological distress and impaired appetite. These cross-sectional findings support routine sleep screening together with psychological and nutritional assessment in this population; whether modifying these factors improves sleep quality requires prospective interventional studies. Keywords: hepatocellular carcinoma, sleep disturbance, hepatic arterial infusion chemotherapy, immunotherapy, targeted therapy

Nurses delivered much of the direct care to COVID-19 patients and were repeatedly exposed to death, infection risk, and shortages of equipment, yet little is known about how Pakistani nurses experienced and managed posttraumatic stress symptoms (PTSS). This qualitative study explored PTSS, experiences of trauma, perceived psychological impact, and coping strategies among nurses who cared for COVID-19 patients during peak pandemic waves. Eight registered nurses working in COVID wards and intensive care units of public hospitals in Islamabad and Rawalpindi were recruited through purposive sampling and took part in individual semi-structured interviews conducted in Urdu and basic English. Data were analysed using Braun and Clarke’s thematic analysis. Four themes were generated: (a) symptoms related to trauma (altered sleep, changes in temperament, emotional reactivity, diminished interest in social life, flashbacks); (b) threats and stress due to COVID-19 (increased workload, direct threat to self and others, sense of isolation, lack of knowledge and equipment); (c) psychological impact of trauma (increased mental health concerns, burnout and compassion fatigue, elevated death anxiety, lack of optimism about the future); and (d) strategies to cope (sharing workload with the team, emotional support from colleagues). Seven of eight nurses described flashbacks, and accounts spanned several DSM-5 symptom clusters, although no diagnostic assessment was used. Peer teamwork and emotional support were the only coping resources reported, and no participant had received formal counselling. Peer solidarity seems to have been an informal resource of resilience where organizational support was absent and institutional psychological services should be built around it.

Objective This cross-sectional study (1) compared social support, psychological-capital dimensions, and both C-MLQ dimensions between students with and without visual impairments; and (2) among students with visual impairments, examined the association between social support and presence of meaning (C-MLQ-P) and tested the a priori hypothesized cross-sectional indirect association through hope. Self-efficacy, resilience, and optimism were examined exploratorily in descriptive/correlational and hierarchical-regression analyses. Methods Participants were 170 students with visual impairments and 294 students without visual impairments from a vocational college in China. They completed measures of social support, psychological capital, and meaning in life. Group differences were examined using MANCOVA with follow-up ANCOVAs. Among students with visual impairments, Pearson correlations and an exploratory hierarchical regression were conducted, and H3 was tested using a single cross-sectional indirect-effect model with social support (ASSS-Total) as the predictor, hope (PPQ-Hop) as the indirect variable, presence of meaning (C-MLQ-P) as the outcome, and age and sex as covariates. Results After adjustment for age and sex, students with visual impairments scored significantly lower on objective support, support utilization, self-efficacy, optimism, presence of meaning, and search for meaning than students without visual impairments, whereas no significant group differences were observed for subjective support, resilience, or hope. Among students with visual impairments, social support was positively associated with the presence of meaning (r = 0.56, p < 0.01). In the H3 model, the total association between social support and presence of meaning was 0.8912 (95% CI [0.6988, 1.0835]), the direct association was 0.3560 (95% CI [0.1655, 0.5465]), and the indirect association through hope was 0.5352 (BootSE = 0.0923, 95% bootstrap CI [0.3680, 0.7239]). Conclusions In this sample from a single Chinese vocational college, social support was positively associated with the presence of meaning, and a significant cross-sectional statistical indirect association was observed through hope. Because the data were cross-sectional, the observed indirect association does not establish temporal ordering or a causal mechanism. Longitudinal and experimental studies are needed to determine whether changes in social support precede changes in hope and presence of meaning.

Objective: Poor insight in obsessive-compulsive disorder (OCD) has been proposed to reflect a more neurodevelopmentally rooted subtype.We examined whether minor physical anomalies (MPAs) and neurological soft signs (NSS), two peripheral markers of aberrant neurodevelopment, distinguish OCD patients according to insight.Methods: Sixty-seven adults with Diagnostic and Statistical Manual of Mental Disorders, fifth edition OCD were assessed with the Yale-Brown Obsessive Compulsive Scale, the Brown Assessment of Beliefs Scale (BABS), the Schedule for the Assessment of Insight, the Waldrop MPA scale and the Neurological Evaluation Scale.Patients were classified as having good (BABS ≤ 12; n = 37) or poor (BABS ≥ 13; n = 30) insight.Firth penalized logistic regression identified independent predictors.Results: The groups were comparable in age, sex, marital status, employment and comorbidity, whereas poor insight was associated with lower education, past suicidal behaviour and greater symptom severity.Total, craniofacial and peripheral MPA scores were higher in the poor-insight group, with an excess of ocular, auricular and oral anomalies.Low-set ears, epicanthus and high-arched palate were the most discriminating.Total NSS and all subdomains except complex motor sequencing were approximately doubled, with large effects for sensory integration and motor coordination.MPA burden predicted poor insight independently of symptom severity, while NSS was the dominant predictor when severity was excluded (apparent area under the receiver operating characteristic curve 0.97; optimism-corrected 0.95).Conclusion: These convergent findings suggest a neurodevelopmental pattern in poor-insight OCD.Given the cross-sectional design, modest sample and absence of a control group, they should be regarded as hypothesis-generating.

هدف: بینش ضعیف در اختلال وسواس فکری-عملی (OCD) به عنوان بازتاب یک زیرگونه با ریشه‌های عصب‌رشدی بیشتر پیشنهاد شده است. ما بررسی کردیم که آیا ناهنجاری‌های جزئی جسمی (MPAs) و نشانه‌های نرم عصبی (NSS)، دو شاخص محیطی رشد عصبی غیرطبیعی، بیماران OCD را بر اساس بینش متمایز می‌کنند یا خیر. روش‌ها: شصت‌وهفت بزرگسال مبتلا به اختلال وسواس فکری-عملی بر اساس ویرایش پنجم راهنمای تشخیصی و آماری اختلالات روانی (DSM-5) با مقیاس وسواس فکری-عملی ییل-براون، مقیاس ارزیابی باورهای براون (BABS)، برنامه ارزیابی بینش، مقیاس MPA والدروپ و مقیاس ارزیابی عصبی مورد ارزیابی قرار گرفتند. بیماران بر اساس بینش خوب (BABS ≤ 12؛ n = 37) یا ضعیف (BABS ≥ 13؛ n = 30) طبقه‌بندی شدند. رگرسیون لجستیک پنالتی‌شده Firth پیش‌بینی‌کننده‌های مستقل را شناسایی کرد. نتایج: گروه‌ها از نظر سن، جنس، وضعیت تأهل، اشتغال و همبودی قابل مقایسه بودند، در حالی که بینش ضعیف با تحصیلات پایین‌تر، رفتار خودکشی قبلی و شدت بیشتر علائم همراه بود. امتیاز کل، کرانیوفاسیال و محیطی MPA در گروه با بینش ضعیف بالاتر بود و فراوانی بیشتری از ناهنجاری‌های چشمی، گوشی و دهانی مشاهده شد. گوش‌های پایین‌نشسته، اپی‌کانتوس و کام قوسی‌شکل بالا بیشترین قدرت تمایز را داشتند. امتیاز کل NSS و همه زیرحوزه‌ها به جز توالی حرکتی پیچیده تقریباً دو برابر بود و اثرات بزرگی برای یکپارچگی حسی و هماهنگی حرکتی مشاهده شد. بار MPA به طور مستقل از شدت علائم، بینش ضعیف را پیش‌بینی کرد، در حالی که NSS پیش‌بینی‌کننده غالب بود زمانی که شدت علائم حذف شد (مساحت زیر منحنی مشخصه عملکرد گیرنده آشکار 0.97؛ تصحیح‌شده با خوش‌بینی 0.95). نتیجه‌گیری: این یافته‌های همگرا الگوی عصب‌رشدی را در OCD با بینش ضعیف پیشنهاد می‌کنند. با توجه به طراحی مقطعی، حجم نمونه متوسط و نبود گروه کنترل، این نتایج باید فرضیه‌ساز تلقی شوند.

21st-century Islamic education demands mastery of non-cognitive spiritual competencies, such as optimism (Husnuzan and Raja’), to mitigate adolescent mental health crises and academic anxiety (qalaq). Teologically anchored in QS. Az-Zumar: 53, QS. Al-Baqarah: 286, and QS. Al-Insyirah verses 5–6, optimism represents a mandatory spiritual-cognitive stance. However, school counseling and Islamic moral nurturing (Tarbiyah Akhlak) remain dominated by conventional, passive-verbalistic methods that trigger student boredom. This study aims to develop a block-based board game called Optimism Bridge to foster an optimistic attitude in Junior High School (SMP) students through an Islamic-integrated cognitive restructuring process.Using the Research and Development (R&D) method with the 4D model limited to the Develop stage, this study involved 20 grade IX-C students at SMP Negeri 42 Medan, two expert validators, and a field practitioner. Data collected via Likert and Guttman questionnaires were analyzed descriptively quantitatively. The results indicate that the media is highly feasible based on validation by media experts (84.00%) and material experts (94.70%), and is highly practical based on responses from counselors (97.50%) and students (84.00%).Philosophically, optimism in Islamic counseling is a cognitive-spiritual skill (Amal Qalbi) intervened through experiential activities. The findings confirm that integrating Seligman’s ABCDE Model and Islamic theological values (Raja’-Ikhtiar-Tawakal) into game mechanics effectively facilitates students’ disputation abilities (Mujahadah an-Nafs) against negative emotions and desperate thoughts (Waswas). Implications for a global audience, this study expands Islamic game-based learning by demonstrating that concrete visualization shifts the school counseling paradigm from passive-doctrinal to an emancipatory internalization of positive divine awareness.

آموزش اسلامی در قرن بیست‌ویکم مستلزم تسلط بر شایستگی‌های معنوی غیرشناختی، همچون خوش‌بینی (حسن‌ظن و رجاء)، به منظور کاهش بحران‌های سلامت روان نوجوانان و اضطراب تحصیلی (قلق) است. خوش‌بینی که ریشه در QS. Az-Zumar: 53، QS. Al-Baqarah: 286 و QS. Al-Insyirah آیات ۵ و ۶ دارد، یک رویکرد معنوی-شناختی الزامی محسوب می‌شود. با این حال، مشاوره مدرسه و پرورش اخلاق اسلامی (تربیت اخلاق) همچنان تحت سلطه روش‌های سنتی و منفعل-کلامی قرار دارد که موجب کسالت دانش‌آموزان می‌شود. هدف این پژوهش، توسعه یک بازی رومیزی مبتنی بر بلوک با عنوان «پل خوش‌بینی» برای تقویت نگرش خوش‌بینانه در دانش‌آموزان متوسطه اول (SMP) از طریق فرایند بازسازی شناختی تلفیق‌شده با آموزه‌های اسلامی است. این مطالعه با استفاده از روش تحقیق و توسعه (R&D) و مدل 4D محدود به مرحله توسعه، با مشارکت ۲۰ دانش‌آموز پایه نهم-C در SMP Negeri 42 Medan، دو ارزیاب خبره و یک کارشناس میدانی انجام شد. داده‌ها از طریق پرسشنامه‌های لیکرت و گاتمن جمع‌آوری و به صورت توصیفی-کمی تحلیل گردید. نتایج نشان داد که این رسانه بر اساس اعتبارسنجی توسط متخصصان رسانه (۸۴٫۰۰٪) و متخصصان محتوا (۹۴٫۷۰٪) بسیار مطلوب است و از نظر عملی بودن نیز بر اساس پاسخ‌های مشاوران (۹۷٫۵۰٪) و دانش‌آموزان (۸۴٫۰۰٪) در سطح بالایی قرار دارد. از منظر فلسفی، خوش‌بینی در مشاوره اسلامی یک مهارت شناختی-معنوی (عمل قلبی) است که از طریق فعالیت‌های تجربی مداخله می‌شود. یافته‌ها تأیید می‌کند که ادغام مدل ABCDE سلیگمن و ارزش‌های الهی اسلامی (رجاء-اختیار-توکل) در مکانیک بازی، به طور مؤثری توانایی مناظره دانش‌آموزان (مجاهدۀ نفس) در برابر هیجانات منفی و افکار یأس‌آور (وسواس) را تسهیل می‌کند. پیامدهای این پژوهش برای مخاطبان جهانی، گسترش یادگیری مبتنی بر بازی اسلامی را نشان می‌دهد و اثبات می‌کند که تجسم عینی، پارادایم مشاوره مدرسه را از حالت منفعل-آموزشی به درونی‌سازی رهایی‌بخش آگاهی الهی مثبت تغییر می‌دهد.