Chronic diseases are a major cause of morbidity and mortality in Lebanon, straining the healthcare system. Patient empowerment is recognized as a strategy to enhance self-management and outcomes. This study aimed to develop and validate a Patient Empowerment Outcomes (PEO) scale adapted to Lebanon and to examine associated factors. A cross-sectional survey was conducted with 640 adults with chronic conditions using structured face-to-face interviews. The questionnaire included sociodemographic and behavioral items, along with four validated tools: the focused Patient Assessment of Chronic Illness Care (fPACIC), General Practice Interpersonal Care (GPIC), Health Empowerment and Self-Management (HESM), and the new PEO scale. Higher PEO scores were significantly associated with older age (B = 0.102, p = 0.002), proactive behaviors (B = 5.486, p = 0.001), and higher GPIC (B = 0.319, p < 0.0001), HESM (B = 0.681, p < 0.0001), and fPACIC (B = 0.104, p = 0.037) scores. Negative associations included greater medication burden (B =  - 0.395, p = 0.029) and health fatalism (B =  - 1.406, p = 0.008). The PEO scale is a valid, culturally adapted tool to assess empowerment in Lebanese patients with chronic diseases. Findings highlight the role of communication, self-management, and informed decision-making in guiding patient-centered interventions and policies.

BACKGROUND:Financial wellbeing and distress have emerged as key social determinants influencing health behaviors, medication adherence, and quality of life. Yet, these constructs remain underexplored in pharmacy and epidemiology research due to the lack of brief, validated, and context-appropriate measurement tools. The widely used InCharge Financial Distress/Financial Wellbeing (IFDFW-8) scale offers strong psychometric evidence but includes items that may not reflect health-related financial strain and may increase respondent burden. OBJECTIVE:This study aimed to develop and validate a concise, contextually applicable 6-item version (IFDFW-6) for use in pharmacy and epidemiological research. METHODS:A cross-sectional study was conducted among adults who had recently visited community pharmacies. The questionnaire included validated measures of financial wellbeing (IFDFW-8), medication adherence (SMAS-7), patient experience and satisfaction (MA-PSQ-18), and quality of life (EQ-5D-5L). Exploratory and confirmatory factor analyses (EFA, CFA) evaluated dimensionality; reliability was examined using Cronbach's α and McDonald's ω; criterion validity was tested against the IFDFW-8 using ROC analysis; and measurement invariance was assessed across gender, health status, and healthcare access groups. RESULTS:Among 501 participants, EFA supported a unidimensional structure explaining 84.3% of variance (factor loadings = 0.878-0.946). CFA confirmed excellent model fit (CFI = 0.997, RMSEA = 0.056, SRMR = 0.008). The IFDFW-6 demonstrated high internal consistency (α = 0.963; ω = 0.963) and strong criterion validity against the parent IFDFW-8 (AUC = 0.993; cutoff = 29.5, sensitivity = 95.8%, specificity = 95.2%). Higher financial wellbeing correlated with better quality of life, greater satisfaction with pharmacy services, and higher medication adherence. CONCLUSION:The IFDFW-6 is a reliable and valid instrument that efficiently captures financial wellbeing/distress and has been refined for contextual applicability in pharmacy and epidemiology research, supporting the integration of economic determinants into health-related studies.

Introduction: This study examined the associations of eHealth literacy, physical activity, and sleep quality with well-being and anxiety among pharmacy students. It also assessed the psychometric performance of the World Health Organization Five Well-Being Index and the Generalized Anxiety Disorder 7-item scale in this population. Methods: A cross-sectional survey was conducted among 583 pharmacy students using validated instruments to assess eHealth literacy, physical activity, sleep quality, psychological well-being, and anxiety symptoms. Confirmatory factor analysis and internal consistency testing were used to evaluate scale performance. Multivariable linear regression was used to identify independent correlates of well-being and anxiety. Results Among 583 pharmacy students, the World Health Organization -5 (WHO-5) and Generalized Anxiety Disorder 7 (GAD-7) scales demonstrated excellent internal consistency (α=0.915 and α=0.926, respectively) and supported one-factor structures. The GAD-7 confirmatory factor analysis (CFA) showed excellent fit (CFI = 0.996, TLI = 0.993, RMSEA = 0.040, SRMR = 0.016). Multivariable regression revealed that higher eHealth literacy was independently associated with higher well-being (B = 0.268) and lower anxiety (B = −0.088). Poorer sleep quality was significantly associated with lower well-being (B = −0.100) and higher anxiety (B = 0.205). Moderate physical activity was linked to higher well-being (B = 1.475) compared to low activity. Conclusion: The WHO-5 and GAD-7 are psychometrically robust tools for this population. The findings underscore that digital health literacy, sleep quality, and physical activity are key modifiable correlates of mental health, highlighting the need for multidimensional support strategies in pharmacy education.

Background: Emergency contraception (EC) is a critical intervention for preventing unintended pregnancies when used promptly after unprotected intercourse. Despite its accessibility, misconceptions and inadequate knowledge about EC among pharmacy students may hinder its effective use. Objective: The aim of this study is to assess the knowledge, attitudes, and practices of pharmacy students regarding emergency contraceptives and explore factors influencing their knowledge, perceptions, and behaviors towards emergency contraception. Methods: This is a cross-sectional study that was conducted between December 2023 and February 2024 at the School of Pharmacy, Lebanese International University. A structured and validated questionnaire was distributed to 366 pharmacy students in their third, fourth, fifth, and PharmD years. The survey was divided into four parts: demographics, knowledge, attitude, and practice. Bivariable and multivariable analysis were conducted to identify demographic factors significantly associated with knowledge about EC and attitudes towards EC. Results: The majority of participants were female (79.8%) with a median age of 22 years. Knowledge about EC was inadequate. Fifth-year and PharmD students, as well as those working in community pharmacies, exhibited significantly higher knowledge scores. Attitudes towards non-prescription EC were predominantly negative. Religious affiliation strongly influenced attitudes, with students without religious ties showing more favorable perceptions. Among students working in pharmacies, only 58.3% reported readiness to dispense EC, citing moral and knowledge-related barriers. Conclusion: Pharmacy students in Lebanon showed inadequate knowledge and largely negative attitudes towards EC, underscoring the need for educational interventions in pharmacy curricula to address misconceptions about EC among pharmacy students and improve their readiness to counsel and dispense EC in their respective communities.

BackgroundHealth-related quality-of-life (HRQOL) is a central outcome in pediatric epilepsy, yet the relative influence of disease severity versus treatment-related burden remains unclear. This study aimed to evaluate HRQOL and assess the respective contributions of clinical characteristics and treatment adverse events in children with epilepsy.MethodsA cross-sectional analysis of 101 children enrolled in a prospective cohort in Lebanon was conducted. HRQOL was assessed using the Arabic QOLCE-55, and treatment-related adverse effects were measured using the Liverpool Adverse Events Profile (LAEP). Multivariable linear regression models, including hierarchical domain-specific analyses, were used to identify factors independently associated with HRQOL.ResultsHRQOL was moderately reduced, with a median QOLCE-55 score of 66 (IQR 55.68–79.41). The physical domain was the most affected (44.44; IQR 30.55–59.72), while the social domain was the least impaired (82.14; IQR 67.85–96.42). In multivariable analysis, higher adverse-effect burden was the strongest factor associated with poorer overall HRQOL (B = −0.97, 95% CI –1.28 to −0.67; p < 0.001), whereas most seizure-related variables were not significant after adjustment. Inclusion of LAEP substantially improved model performance (ΔR2 up to 0.310) and was associated with poorer HRQOL across all domains. Longer epilepsy duration remained associated with poorer physical HRQOL, and focal epilepsy with lower social and emotional scores.ConclusionIn this cohort, HRQOL was more strongly associated with treatment-related adverse effects than with most seizure-related variables. Treatment tolerability appears to represent an important and modifiable correlate of well-being. Routine assessment of adverse effects may enhance patient-centered care.

Background:Patient satisfaction is a key indicator of healthcare quality and a driver of medication adherence and trust in community pharmacy practice. However, validated instruments that specifically assess patients' satisfaction with community pharmacists and pharmacies remain scarce. This study aimed to develop and validate the 9-item Patient Satisfaction Questionnaire (PSQ-9), a concise tool tailored to community pharmacy settings, and to identify factors associated with patient satisfaction. Methods:A cross-sectional online survey of 501 adults from all Lebanese districts was conducted between February and May 2025. The PSQ-9 was derived from the modified 18-item PSQ using exploratory (EFA) and confirmatory (CFA) factor analyses on two independent subsamples. Psychometric testing included internal consistency, test-retest reliability, construct validity, and multigroup CFA to assess measurement invariance. Multivariable linear regression identified correlates of satisfaction. Results:The PSQ-9 demonstrated a two-factor structure, Interpersonal Care and Professional Engagement and Affordability and Informational Assurance, with excellent model fit (CFI = 0.984, RMSEA = 0.056, SRMR = 0.027) and reliability (α = 0.904, ω = 0.910, ICC = 0.729). Measurement invariance was established across gender, health status, and access to care. Higher satisfaction was associated with easier access to healthcare (B = 1.470, P = 0.012), pharmacist counselling from time to time (B = 1.616, P = 0.004) or regularly (B = 1.864, P = 0.008), longer counselling (>10 min; B = 2.441, P = 0.004), higher patient expectations (B = 0.356, P = 0.001) and perceptions (B = 0.110, P = 0.002), and fewer communication barriers (B = -0.235, P = 0.005). Conclusion:The PSQ-9 is a valid, reliable, and contextually adapted instrument for assessing patient satisfaction with community pharmacy services. Its brevity and psychometric robustness make it ideal for large-scale surveys and benchmarking, supporting patient-centered and equitable pharmacy practice improvement.

Background: Osteoporosis is considered one of the most important postmenopausal problems. The absence of efficacy markers and intolerable side effects hinders treatment outcomes. This study aimed to assess adherence to medications, quality of life and treatment satisfaction among Lebanese osteoporotic women. Methods: This cross-sectional study was conducted between March-December 2020 in community and outpatient settings distributed in all Lebanese districts. A validated questionnaire was used to gather information through face-to-face and online interviews. Data was analyzed using a statistical package for social science (SPSS). Results: A total of 72 patients were recruited with a mean age of 60.40 of +/- 8.86 years. Almost all women (94.40%) were menopause with a mean age of 48.97 +/- 4.78 years (mean +/- SD). The majority were married (83.30%), had 2 or more children (81.90%), and were educated (86.10%). The adherence score was positively and significantly associated with the duration of smoking (beta=0.22, CI=0.03-0.41, P-value=0.027) and calcium intake (beta=5.68, CI=1.56-9.80, p-value=0.009). On the other hand, a negative association was noted with vitamin D intake (beta=-15.34, CI=-27.95,-2.73, p-value=0.019). Conclusion: Treatment satisfaction was significantly associated with the participant's age and menopause status. Proper education and awareness campaigns can help young women prevent the development of osteoporosis.

Interprofessional education (IPE) is vital for preparing pharmacy students for collaborative practice but is often constrained by logistical challenges. This study examined the preliminary impact of an AI-enhanced simulated interprofessional learning intervention on pharmacy students’ self-reported interprofessional competencies and perceived readiness for AI use in healthcare, using an antimicrobial stewardship (AMS) scenario to assess the application of clinical decision-making. A pilot quasi-experimental study with an explanatory mixed-methods design was conducted among pharmacy students (n = 112). The intervention involved an AI-enhanced simulation using virtual avatars representing healthcare roles within a recurrent urinary tract infection case. Outcomes were assessed using the Interprofessional Collaborative Competency Attainment Survey (ICCAS), the Medical Artificial Intelligence Readiness Scale (MAIRS), and an AMS knowledge questionnaire. Paired t-tests, repeated-measures MANCOVA, and multiple linear regression analyses were performed, and thematic analysis was used for qualitative data. Participants reported significantly higher post-intervention self-reported scores across all outcomes. ICCAS scores increased from 58.82 ± 14.67 to 68.52 ± 12.45, MAIRS from 75.16 ± 10.85 to 82.12 ± 9.49, and AMS from 6.21 ± 1.74 to 8.08 ± 1.35 (all p < 0.001), with all subscales showing significantly higher post-values (p < 0.001). MANCOVA confirmed a significant overall time effect (p < 0.001). Qualitative findings highlighted students’ perceived improvements in communication, teamwork, clinical reasoning, and critical awareness of AI limitations. Higher academic year, prior IPE exposure, simulation experience, and digital literacy were significantly associated with higher outcome scores. Students without prior IPE exposure showed larger pre-post ICCAS change scores than those with prior IPE exposure (Δ difference = 4.2, p = 0.008, d = 0.52). This pilot study suggests that AI-enhanced simulated interprofessional learning may be associated with improvements in students’ self-reported collaborative competencies, perceived readiness for AI use in healthcare, and short-term AMS knowledge scores. Given the single-group pre-post design and short-term assessment, findings should be interpreted as preliminary and require confirmation through future controlled randomized and longitudinal studies.

[This corrects the article DOI: 10.1371/journal.pone.0345153.].

BACKGROUND:Non-medical use of cognitive enhancers (CEs) is underexplored in the Middle East and North Africa despite high academic stress and inconsistent drug regulation. Pharmacy students, given their pharmacological training and medication access, may represent a key population for surveillance. This study examined CE misuse prevalence and correlates among Lebanese pharmacy students. METHODS:A registry-based, design-weighted cross-sectional survey was conducted from March to May 2025 among undergraduates at Lebanon's three largest pharmacy programs. Of 1,003 eligible students, 438 completed the survey (AAPOR response rate RR1 = 43.7%). Post-stratification weights aligned the analytic sample with university-reported margins for gender, academic year, and sector. Non-medical CE use was defined as unprescribed use of donepezil, memantine, racetams, methylphenidate, or modafinil in the past 12 months. Factors associated with use were assessed using DAG-guided multivariable logistic regression. RESULTS:Weighted 12-month prevalence of non-medical prescription CE use was 28.1% (95% CI: 23.7-32.9). A secondary composite endpoint encompassing prescription misuse and over-the-counter supplements used with explicit cognitive-enhancement intent reached 54.6%. Most common agents were donepezil (12.6%), racetams (11.3%), and methylphenidate (10.5%). Factors independently associated with use included advanced academic year (aOR = 2.12; 95% CI: 1.41 to 3.18) and lower GPA (<3.2 versus ≥3.6; aOR = 1.83; 95% CI: 1.15 to 2.92). Gender, employment, and university type were non-significant. CONCLUSIONS:Non-medical use of prescription CEs is prevalent among Lebanese pharmacy students, with anti-dementia agents and racetams exceeding classic stimulants. These findings underscore the need for targeted medication governance and ethics-integrated pharmacy education.

Background Gastroesophageal reflux disease (GERD) is a common condition influenced by lifestyle, clinical, and psychosocial factors. This study examined the relationship between GERD symptoms and perceived stress among Lebanese adults, while accounting for key demographic, dietary, and clinical variables. Method A cross-sectional study was conducted among Lebanese adults between January and September 2024 using an online self-administered questionnaire. GERD symptoms and perceived stress were assessed using the GERDQ and PSS-10 scales. Bivariate analyses followed by multivariable logistic regression were performed to identify factors independently associated with GERD symptoms. Results A total of 440 participants were included (mean age of 36.4 ± 16.96 years), of whom 28.4% had probable GERD symptoms. Most participants (83.2%) reported moderate stress levels with a mean PSS score of 19.74±5.05. Higher perceived stress was independently associated with increased odds of GERD symptoms (ORa=1.110). Additional correlates included dietary factors (frequent intake of fatty/fried foods, carbonated beverages, and caffeinated drinks), medication-related factors (NSAIDs, bisphosphonates, and iron supplements), former smoking, and a personal or family history of gastrointestinal disease. Being married was associated with lower odds of GERD symptoms. Conclusion Probable GERD symptoms were independently associated with perceived stress, dietary habits, smoking history, medication use, and gastrointestinal disease history. These findings support a biopsychosocial understanding of GERD symptom burden and provide further evidence that psychosocial factors should be considered when investigating gastrointestinal health in vulnerable populations.

Mobile health (mHealth) applications (apps) are increasingly used to support health promotion and chronic disease management. However, evidence from Middle Eastern low-resource settings remains limited. This study assessed perceptions, usage patterns, barriers, and determinants of mHealth apps utilization among adults visiting community pharmacies in Lebanon. A cross-sectional survey was conducted between February and September 2025 across selected community pharmacies in Lebanon’s six main districts. Face-to-face interviews collected sociodemographic data, perceptions, usage patterns, and barriers. Bivariate analyses identified factors associated with mHealth use, and multivariable logistic regression determined independent predictors. Among 514 participants (mean age 38.9 ± 8.6 years), 71.6

With increasing complexity in patient care, IPE has been proposed to improve interprofessional teamwork and improve outcomes. This study was conducted to evaluate the impact of a structured IPE activity on students’ collaborative perceptions and competencies. This study employed a quasi-experimental pre-post intervention design to assess changes in perceptions and self-reported competencies using validated tools (SPICE-R2 and ICCAS). The IPE intervention comprised a full day didactic sessions and case studies. Paired-samples t-tests, repeated measures ANOVA, and MANCOVA were utilized to assess changes and identify predictors. A total of 182 students (pharmacy: 66.5

Academic self-efficacy (ASE), the belief in one’s ability to succeed in academic tasks, plays a crucial role in student motivation, learning, and performance. Reliable measurement of this construct is essential for identifying students’ strengths and areas for improvement. This study aims to translate and validate the Academic Self-Efficacy Scale for use among university students from six different Arab countries. Using the Snowball sampling technique, participants (n = 2131), university students six Arab countries (i.e., KSA, UAE, Egypt, Lebanon, Oman, and Kuwait), answered the demographic questions and completed the Arabic Academic Self-Efficacy Scale, the Depression Anxiety Stress Scale-8, and the Multidimensional Social Support Scale. Confirmatory Factor Analysis proved a one-factor solution for the ASE scale. Adequate composite reliability was found (ω =.96; α =.96). Convergent and concurrent validity was assessed and proven by a negative correlation with measures of psychological distress and positive correlation with measures of social support. Our translation of the ASE scale was invariant across sexes and countries, with females scoring significantly higher than males. Our Arabic version of the ASE scale is a validated and reliable tool for assessing ASE in Arabic speaking populations, and shall provide means for assessing students’ confidence in their academic abilities and help improve student support.

Background/Objectives: Cancer ranks as the second most prevalent cause of death worldwide, according to the World Health Organization. Approximately one in six global deaths is attributed to cancer. Among females, breast cancer stands out as the most frequent type of tumor. Raloxifene (RLX), recognized as a selective estrogen receptor modulator, has been employed as a therapeutic option in treating breast cancer among postmenopausal women. The objective of this study was to investigate the anticancer potential of raloxifene-loaded hexosomes, nanoliposomes, and nanoniosomes to identify the most effective formulation. Methods: The particle size, zeta potential, entrapment efficiency, and structural elucidation of the various nanovesicle formulations was validated; Results: Each nanocarrier exhibited a negative surface charge, nanometric size, and a reasonable encapsulation efficiency. Cytotoxicity of the different raloxifene-loaded nanovesicles on MCF-7 breast cancer cell lines and MCF10 non tumorigenic cells revealed the substantial cytotoxic activity of the hexosomal nanocarrier compared to the other nanovesicles, exhibiting the lowest IC50 = 45.3 ± 1.10 µM. Conclusions: The RLX-loaded hexosomal formulation showed superior cytotoxic activity, indicating its potential as a highly effective therapeutic agent. To fully understand its capabilities and mechanisms, further in vitro characterization studies are necessary.

Single-use plastic bottles (SUPBs) are a significant contributor to plastic waste, posing a major environmental threat. Pharmacy students play a crucial role in advocating for sustainable practices in their future careers as healthcare providers. This study aimed to explore the knowledge, attitudes, and behaviors of Lebanese pharmacy students towards plastic use in July 2023 at Lebanese International University (LIU). A structured questionnaire was used to examine the frequency and circumstances of SUPBs usage, personal versus professional disparities in consumption, awareness of environmental issues, recycling practices among students, and barriers preventing them from switching to reusable options. A key finding was the disconnect between awareness and behavior: although most students (61.6%) recognized the environmental impact of plastic waste, they still consumed one to three plastic water bottles daily. Additionally, most students (76.1%) assumed that plastic water bottles were meant for single use. Furthermore, 28.4% of those interviewed admitted to not recycling at all. Barriers to adopting reusable alternatives included convenience and lack of access. Our analysis identified a statistically significant correlation between age and environmental concerns, suggesting a decline in environmental awareness as age increases. These findings underscore the need for targeted sustainability initiatives to encourage reusable bottle adoption and prepare future pharmacists to advocate for environmental responsibility.