Search Results (8,569)

Background/Objectives: Breast cancer is the most common malignancy among women worldwide. Vacuum-assisted breast biopsy (VABB) has emerged as a minimally invasive alternative to surgical excision, but it may cause post-biopsy scarring that could mimic or obscure malignancies on follow-up imaging. This study aimed to evaluate the imaging characteristics, evolution, and clinical implications of post-VABB scar formation. Methods: We conducted a retrospective study of patients who underwent mammographic or magnetic resonance imaging-guided VABB at our institution between January 2010 and December 2020 and whose follow-up report describes a post-biopsy scar. Patients with malignant or high-risk lesions requiring subsequent surgery or prior breast surgery were excluded. Post-biopsy follow-up mammograms and ultrasounds were reviewed by a fellowship-trained breast radiologist for scar formation, visibility across imaging modalities, and evolution over time. Statistical analysis was performed to assess associations between scar detection and patient or lesion characteristics. Results: Thirty-seven patients (39 lesions) with documented post-biopsy scarring on follow-up imaging reports met the study inclusion criteria. The mean age at biopsy was 51.97 ± 12.40 years. Lesions were almost equally distributed between the right and left breasts, with 19 cases involving the right breast (48.7%) and 20 cases involving the left breast (51.3%). Most cases did not need any workup, except for six cases, where two required further biopsy and four required short-term follow-up. No malignancy was detected during the available follow-up or additional evaluation. Twenty-two scars regressed over time. The estimated mean time to scar regression was 69.47 months. Conclusions: Post-biopsy scarring was documented in a small subset of our institution’s VABB cases over the study period and may resemble malignant findings, particularly on tomosynthesis. Awareness of typical scar characteristics, careful documentation of biopsy sites, and correlation with clip markers are essential to avoid unnecessary interventions. Full article

Background/Objectives: Communication training in undergraduate nursing skills courses is often overshadowed by procedural skill acquisition, leaving limited opportunities for students to develop patient-centered communication skills and engage in reflective learning. This study evaluated a reflection-integrated CICARE communication program embedded in a Fundamentals of Nursing skills course and explored students’ learning experiences. Methods: A quasi-experimental study with an embedded qualitative component was conducted among second-year undergraduate nursing students in China. The quantitative component used a non-equivalent control group design, while reflective journals from the Intervention Group provided qualitative data on students’ learning experiences. Two intact classes were assigned to the Intervention Group (n = 65), and two intact classes were assigned to the Control Group (n = 66). The Intervention Group received an 18-week CICARE-based communication program integrated into skills training, including scenario-based role-play, emotional cue recognition, demonstration videos, feedback, and reflective journals. The Control Group received conventional skills training. Outcomes included communication competence, empathy, professional identity, clinical judgment, and course performance. Analysis of covariance was used to compare post-intervention outcomes after adjustment for baseline scores. Reflective journals from the Intervention Group were analyzed thematically. Results: After adjustment for baseline scores, the Intervention Group showed significantly higher communication competence than the Control Group (adjusted mean difference = 2.699, 95% CI: 0.108–5.291, p = 0.041). Empathy was also higher in the Intervention Group (adjusted mean difference = 3.796, 95% CI: 0.538–7.053, p = 0.023). The between-group difference in professional identity was not statistically significant (p = 0.073). The Intervention Group achieved higher total clinical judgment scores than the Control Group (31.52 ± 5.50 vs. 27.20 ± 6.45, p < 0.001), with significant differences in noticing, interpreting, and reflecting. Course performance was also higher in the Intervention Group. In their reflective journals, students described greater patient-centered awareness, attention to patients’ emotional needs, professional reflection, and motivation for self-directed learning. Conclusions: Integrating CICARE-based communication training with reflective learning may strengthen communication competence, empathy, clinical judgment, and course performance in undergraduate nursing skills education. Further studies with longer follow-up are needed to determine whether the observed differences persist over time and whether professional identity and action-oriented clinical responses improve with longer educational exposure. Registration: This study was not registered. Full article

Fat-poor angiomyolipoma (fp-AML), a common benign renal mass, closely mimics renal cell carcinoma (RCC) on preoperative computed tomography (CT), frequently resulting in unnecessary surgical intervention. This multicenter retrospective study aimed to develop and externally validate an AI-assisted radiomics model based on triphasic contrast-enhanced CT to accurately distinguish fp-AML from RCC. A total of 655 eligible patients with sporadic solid renal lesions were enrolled and divided into a training cohort (n = 364), an internal test cohort (n = 156), and an independent external validation cohort (n = 135), with a stable fp-AML to RCC ratio of approximately 1:4. Tumor segmentation was performed using an nnU-Net-assisted workflow with radiologist refinement, followed by cross-phase image registration, radiomic feature extraction, LASSO feature reduction, and random forest classifier construction. The established model achieved favorable and stable diagnostic performance across all cohorts, with AUCs of 0.868 in the training and internal test sets and 0.803 in the external validation set, maintaining reliable discrimination even in the small renal mass subgroup (≤4 cm). This externally validated AI radiomics model demonstrates promising diagnostic performance across centers and may serve as a preoperative decision-support tool for differentiating fp-AML from RCC; however, prospective multicenter validation is required before routine clinical implementation. Full article

Background: Exercise intolerance is a common symptom in patients with chronic heart failure (CHF) and is often associated with reduced pulmonary function. Breathing exercise, including inspiratory muscle training (IMT) has been shown to alleviate respiratory symptoms in patients with pulmonary and cardiac disease. The purpose of this systematic review is to assess the impact of IMT on maximal inspiratory pressure (Pimax), diaphragm thickness, functional vital capacity (FVC), dyspnea and maximum oxygen uptake (VO_2peak) in patients with CHF. Methods: Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the IMT effect on pulmonary function studies. Eligibility criteria included pulmonary function measurements following IMT in patients with CHF. A continuous random effect model (PROSPERO-CRD420261360295) was used to calculate standard mean differences (Std.MD) in all outcomes (between an experimental and control group). Results: A total of 395 participants (13 randomized controlled trials) were identified. More studies indicate improvement in Pimax after IMT (Pimax: Std.MD: 1.07; 95%CI, 0.72–1.42; p < 0.00001). Functional vital capacity (Std.MD, 0.41; 95%CI, 0.03–0.79; p = 0.03) and dyspnea (Std.MD, 1.11; 95%CI, 0.57–1.66; p < 0.0001) were also improved. Moreover, VO_2peak assessed by cardiopulmonary exercise testing before and after IMT showed statistical significance (VO_2peak: Std.MD: 0.86; 95%CI, 0.06–1.66; p = 0.04) in trained patients with CHF compared to controls. Conclusions: The meta-analysis indicates that isolated IMT performed either as short- to medium-term intervention (4 to 8 weeks) with moderate to high intensity (40 to 90% Pimax) or long-term program (8 to 12 weeks) with low intensity (30% Pimax) promotes pulmonary function and metabolic responses. More studies are required to examine the impact of IMT on diaphragm thickness in patients with chronic heart failure. Full article

Chemistry teaching in youth and adult education has faced challenges related to students’ disengagement, interrupted educational trajectories, and difficulty in connecting scientific concepts with learners’ everyday and professional experiences. In Brazil, Professional and Technological Secondary Education Integrated with Youth and Adult Education (PROEJA) aims to address its challenges by combining basic education with vocational training. This study investigated how a contextualized pedagogical intervention based on the production of aromatic candles contributed to students’ engagement, contextualized conceptual learning and vocational reflection in a technical administration course offered at the Brazilian Federal Institute (IFMS-CG), Campo Grande, Mato Grosso do Sul, Brazil. A qualitative participatory action research design was adopted, and qualitative data were generated through participatory observations, classroom interactions, students’ written reflections, photographic records, and reflective discussions. Data were interpreted by Reflexive Thematic Analysis. Throughout the intervention, students explored Organic Chemistry concepts related to hydrocarbons, n-paraffins, physicochemical properties, volatility, combustion, formulation and laboratory safety while simultaneously discussing entrepreneurship, branding, product development and income generation. The qualitative findings demonstrated students’ active participation, collaborative teacher–student interactions, contextualized conceptual learning and a broader perception of Chemistry as a socially and professionally relevant discipline connected to everyday life, vocational education and entrepreneurial practice. Students’ written reflections further revealed that scientific knowledge was increasingly associated with technological innovation, product quality, professional opportunities and income generation. These findings suggest that contextualized, interdisciplinary and humanized pedagogical practices may promote meaningful scientific learning while strengthening vocational reflection and reinforcing the relevance of Chemistry within youth and adult professional and technological education. Full article

Background: Clinical pharmacists play a crucial role in identifying and resolving drug-related problems (DRPs) in hospitals. However, there is limited empirical evidence concerning their effect on service organizations in smaller regional facilities in Saudi Arabia. Methods: A retrospective serial cross-sectional study was conducted using three years of administrative data (2023–2025) from two public hospitals in the Al-Baha region. A total of 1812 different database records were identified after full-scale data cleaning, validation, and deduplication. The statistical framework included chi-square test of independence, pairwise two-proportions Z-test, three multivariate binary logistic regression models, Cramer’s V association analysis, and Ward’s hierarchical cluster modeling. Results: Active intervention rates significantly increased from 48.9% in 2023 to 72.4% in 2024 (z = −8.58, p < 0.001), stabilizing at 69.6% throughout 2025 (p < 0.001 versus the 2023 baseline), because 2023 data came from a different source system than 2024 to 2025 data, this pattern is reported descriptively rather as a programmatic integration. The most frequent clinical actions addressed therapy optimization (28.4%), inappropriate dosage regimens (23.6%), and missing drug orders (18.8%). Most entries recorded were for adult intensive care units (ICUs) (74.1%), and most involved patients aged 65 years or older (61.1% of records). ICU setting was independently associated with the intervention being classified as therapy optimization (adjusted odds ratio [aOR] 2.64, p < 0.001), but it was an inverse predictor of dosage-error tracking (OR 0.30, p < 0.001). Conclusions: This is among the first serial cross-sectional studies to build an evidence-based framework describing clinical pharmacy practices in the Al-Baha region, showing pharmacists’ roles and prioritizing advanced clinical training programs, reinforcing the need for critical analysis of health cluster policies across peripheral Saudi networks. Full article

Damage identification in instrumented structures is often framed through modal-parameter changes, finite element updating, or supervised classifiers. These approaches are powerful, but they require an explicit structural model, identified modes, labeled damage cases, or expert choices about reference sensors. This paper introduces a new data-driven and training-free approach with limited physical priors, defining a sensor network where each sensor is a node and the edges are defined from the spatial correlation of sensor responses. The idea is to use each sensor time history as the measured structural dynamics feature while damage is localized from the edges, whose correlations change relative to a baseline. The method is demonstrated on a full-scale seven-story reinforced-concrete shear-wall building tested at UC San Diego, considering four progressive earthquake-induced damage states and one brace-modification state. The results are compared with those obtained from a previously published finite element model. The results reveal that this network-based approach localizes the damage states in agreement with previous studies with limited prior requirements and low computational cost. Beyond damage localization, this network representation provides sensor centrality, allowing informative sensors to be selected from data rather than chosen randomly or only from experimental intuitions. For the case study, using this sensor network, we find the most central sensors, those carrying the most information with reduced trial-and-error and reduced expert intervention, and use them to recover the first three natural frequencies as a secondary dynamic check. The results show that spatial correlation networks can screen for damage, localize affected regions, and guide modal parameter extraction without building an FE model. This study opens a research avenue in which network representations of multi-sensor structural dynamics complement traditional modal analysis for structural health monitoring, with dense or heterogeneous sensing systems. Full article

Conventional ultrasound phantoms typically lack anatomical surface geometry and procedural access constraints, limiting the transferability of acquired skills to clinical practice. The objective of the present work was to develop and describe such a platform for ultrasound-guided thyroid nodule puncture training, including its construction and initial ultrasound appearance. We present a modular, body-mimicking ultrasound phantom platform comprising three components: an anatomically shaped epoxy composite chassis cast from a healthy volunteer and covering the cervical and upper thoracic region, interchangeable gelatin-based inserts representing thyroid (including puncture target lesions) and surrounding tissue structures, and an integrated dual-camera optical feedback system for real-time and post-procedural needle trajectory visualization. Two chassis configurations reflecting different chin and shoulder positions allow deliberate modulation of procedural difficulty. Insert composition can be varied to simulate tissues of differing echogenicity and density, including liquid-filled targets. Under appropriate storage and disinfection conditions, inserts remained usable for up to four weeks in qualitative observation. The optical feedback system supports self-directed learning and structured debriefing. In combination with magnet-based ultrasound needle guidance technology, the platform is intended to support a longitudinal, competency-based training concept with quantifiable performance metrics, enabling systematic documentation of individual learning curves. The presented system is designed to more closely replicate the anatomical and procedural complexity of clinical ultrasound-guided interventions than conventional phantoms and represents a flexible simulation platform for interventional ultrasound education. Full article

Seasonal variation in SARS-CoV-2 transmissibility is difficult to estimate directly from year-round epidemic data because interventions, behavior, reporting, immunity, and viral evolution change concurrently. We therefore asked whether cross-country differences observed during the initial exponential-growth phase could be used to infer country-specific seasonal modulation. Early-pandemic basic reproduction numbers (R₀) from 118 countries were linked to 96 harmonized environmental and population-level predictors. Among nine candidate algorithms evaluated across 100 repeated train–test splits, ridge regression using the combined predictor set provided the best balance of predictive accuracy, generalization, and temporal stability. The selected model was then driven by daily climatological covariates to reconstruct annual baseline R₀(t) profiles. Predicted transmissibility generally peaked during winter in the Northern Hemisphere and approximately six months later in the Southern Hemisphere, whereas equatorial countries showed weaker or multimodal patterns. Seasonal forcing amplitude increased strongly with absolute latitude (r = 0.85; mean 0.064 across 77 temperate countries), and predicted R₀ peaks aligned more closely with minimum ultraviolet radiation than with minimum temperature. These ecological associations do not establish causality, but they provide country-specific seasonal-forcing parameters for epidemic models and a baseline environmental context for comparing early-pandemic trajectories. Full article

This study assessed the feasibility of a technology-supported high-intensity interval training (HIIT) program for occupational drivers. A multiphase feasibility study incorporating participant feedback was conducted in Flanders, Belgium, including consultation, pilot, and intervention phases. Occupational drivers were randomized to a HIIT group, an active control group (mindfulness program), or a passive control group (no intervention). The 16-week, equipment-free HIIT program consisted of two 15-min sessions per week, delivered via a technology-supported mobile application, preceded by a 2-week baseline. Primary feasibility outcomes included program completion, session adherence, intervention fidelity, adverse events, and participant experiences, while changes in health-related outcomes were assessed as secondary exploratory outcomes using validated questionnaires. During the consultation (n = 11) and pilot (n = 2) phases, participants reported positive attitudes toward the intervention. Key barriers, including scheduling constraints (n = 5) and bicycle transportation (n = 4), informed refinements such as an equipment-free, technology-supported protocol and flexible scheduling. Of the 23 randomized participants across all groups, 16 participants initiated their assigned study protocol, and 10 completed all assessment points and were included in the final analysis. Of the nine participants allocated to the HIIT group, four initiated the intervention (44.4%), and three completed the program (33.3% of those allocated; 75% of those who initiated). Among the three completers, mean session attendance was 80.2%. Session fidelity was well maintained, but exercise-intensity fidelity could not be objectively confirmed. No exercise-related adverse events were reported. Participant feedback indicated generally positive usability but mixed acceptability of the technology-supported HIIT program among the three participants who completed the intervention. Exploratory individual-level changes in health-related outcomes were heterogeneous, with lower mean scores for depression, anxiety, stress, and fatigue. A technology-supported HIIT program was feasible among the small subgroup of occupational drivers who initiated it, with high session attendance. However, considerable pre-initiation attrition and low retention limit its feasibility for the broader target population. Observed health-related outcomes were heterogeneous and should be interpreted descriptively, warranting evaluation in a fully powered randomized controlled trial. Full article

Background/Objectives: Older adults residing in long-term care facilities (LTCFs) are at increased risk of poor oral health because of functional dependence and limited access to professional oral healthcare. Although oral healthcare education programs for care workers improve knowledge and performance, evidence of their effects on residents’ biological oral health outcomes remains limited. This study evaluated the effects of a care worker-centered oral healthcare program on oral inflammatory status in LTCF residents using salivary interleukin-1 beta (IL-1β) as an objective biomarker. Methods: A single-group pretest–posttest quasi-experimental study was conducted in two LTCFs in the Republic of Korea. Forty care workers completed a structured oral healthcare education program and provided daily oral healthcare to residents for 4 weeks. Saliva samples were collected before and after the intervention, and salivary IL-1β concentrations were measured using enzyme-linked immunosorbent assay. Changes in IL-1β concentrations were analyzed using the Wilcoxon signed-rank, Mann–Whitney U, and Kruskal–Wallis tests. Results: Thirty-seven residents completed the study. Median salivary IL-1β concentrations significantly decreased from 19.33 pg/mL (interquartile range [IQR], 11.49–34.66) at baseline to 10.78 pg/mL (IQR, 0.65–33.64) after the intervention (Z = −3.764, p = 0.001). Greater reductions were observed among residents with greater functional dependence, whereas limited communication ability or oral care refusal was associated with minimal improvement. Conclusions: A care worker-centered oral healthcare program significantly reduced salivary IL-1β concentrations among older adults residing in LTCFs. Findings support care worker training and highlight the use of salivary IL-1β as an objective biomarker for evaluating oral healthcare interventions. Full article

Background: Combat sports require athletes to repeatedly perform explosive actions under conditions of fatigue, demanding high levels of neuromuscular coordination, reactive agility, and intermittent effort capacity. This study examined changes in biomechanical and neuromuscular performance over a 15-week period during which competitive Sambo athletes completed a CrossFit-based functional training program alongside their regular sport-specific training. Methods: Forty male Sambo athletes (22.4 ± 2.6 years) completed a longitudinal repeated-measures intervention consisting of three weekly CrossFit-based sessions integrated into regular sport-specific training. The program was periodized across four progressive mesocycles emphasizing functional strength, explosive power, reactive agility, and fatigue resistance. Pre- and post-intervention assessments included upper- and lower-limb reaction speed, vertical jump height, repeated jump endurance, reactive agility, grip endurance, body-weight squat performance, Romanian deadlift repetitions, and the Special Judo Fitness Test (SJFT). Statistical analyses included paired-samples t-tests or Wilcoxon signed-rank tests with Benjamini–Hochberg false discovery rate correction (α = 0.05). Results: Significant post-intervention improvements were observed in most performance variables. Upper- and lower-limb reaction performance improved by 22.9% and 9.7%, respectively (p < 0.001), while vertical jump height increased by 11.4% and repeated jump endurance by 16.6% (p < 0.001). Reactive agility time decreased by 6.6% (p < 0.001), indicating faster cognitive-motor responsiveness. Functional strength improved substantially, with increases of 43.7% in body-weight squat performance and 71.9% in Romanian deadlift repetitions (p ≤ 0.001). Grip endurance improved by 6.3% (p = 0.007), whereas maximal handgrip strength showed no significant changes. The SJFT index decreased by 5.0% (p < 0.001), reflecting enhanced intermittent effort efficiency and fatigue tolerance. Large effect sizes were identified for upper-limb reaction speed (d = 1.42), explosive endurance (d = 1.46), and reactive agility (d = 0.96). Conclusions: Over the 15-week study period, participation in a CrossFit-based functional training program integrated into regular Sambo practice was associated with improvements in several biomechanical and neuromuscular performance outcomes, including reaction performance, explosive power, agility, muscular endurance, and sport-specific work capacity. However, because the study did not include a control group, these changes cannot be attributed exclusively to the CrossFit-based intervention. Controlled studies are required to distinguish intervention-specific effects from seasonal training adaptations, continued sport-specific practice, and test familiarization. Full article

Background: Executive functions (EFs) decline with aging, impacting functional independence. While resistance training (RT) is a promising non-pharmacological intervention, the optimal modality and duration for cognitive benefits remain unclear. Flywheel RT (FRT) imposes greater motor control and attentional demands than traditional RT (TRT), potentially enhancing EFs. Objective: To compare the effects of a 36-week FRT versus TRT program on executive function and serum insulin-like growth factor 1 (IGF-1) levels in healthy older women. Methods: This parallel-group randomized controlled trial allocated 64 older women (overall mean age 66.8 ± 4.6 years; FRT group: 68.0 ± 4.8 years; TRT group: 65.5 ± 4.1 years) to either FRT (n = 25) or TRT (n = 21) for two weekly sessions over 36 weeks. Executive function was assessed using the Victoria Stroop Test (inhibitory control), Digit Span Test (working memory), and Trail Making Test (cognitive flexibility). Serum IGF-1 was quantified via chemiluminescence. Intention-to-treat analyses with ANCOVA were performed. Results: After 36 weeks, both groups showed significant within-group improvements in inhibitory control (mean reduction from pre to post: FRT: 15.2 ± 10.4 to 14.8 ± 7.4 s; TRT: 20.4 ± 11.8 to 15.6 ± 7.3 s; p = 0.028, ηp² = 0.38) and working memory (Digit Span Forward: FRT: 6.2 ± 1.7 to 7.9 ± 2.0; TRT: 6.7 ± 1.5 to 8.7 ± 1.8; p < 0.001, ηp² = 0.84). The B/A ratio of the Trail Making Test improved significantly more in the FRT group (73.0 ± 65.2 to 87.5 ± 68.1 s) compared to the TRT group (67.3 ± 54.1 to 137.7 ± 83.6 s; group × time interaction: p = 0.001, ηp² = 0.13). No significant changes in serum IGF-1 concentrations were observed in either group (FRT: 112.9 ± 25.4 to 115.3 ± 21.3 ng/mL; TRT: 104.7 ± 27.5 to 103.0 ± 28.9 ng/mL; p = 0.88, ηp² = 0.002). Adherence was high (only 4 out of 46 participants did not complete all 72 sessions), and no severe adverse events were reported. Conclusions: Flywheel training appears particularly effective for enhancing cognitive flexibility, likely due to its higher cognitive-motor demands. The absence of significant changes in circulating IGF-1 suggests that the observed cognitive benefits may not be mediated by systemic endocrine pathways, although this does not exclude the possibility of local central nervous system adaptations or changes in other neurotrophic factors not assessed in this study. Full article

Background: Retinal microvascular assessment has emerged as a promising non-invasive approach for evaluating vascular health. Recent advances in retinal imaging technologies have enabled detailed characterization of retinal vascular structure and function, raising interest in their potential role as biomarkers of exercise-related vascular adaptation. This systematic review with narrative synthesis aimed to summarize current evidence regarding the relationship between exercise, physical fitness, and retinal microvascular biomarkers. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published from January 2021 to June 2026, followed by a supplementary update search to identify eligible publications available through 31 July 2026. Search terms combined retinal microvascular assessment techniques with terms related to exercise, physical activity, physical fitness, and exercise training. Following screening and eligibility assessment, 42 publications were included in the final qualitative synthesis, comprising 20 publications identified through the initial search and 22 additional publications identified through the supplementary update search. Several publications represented complementary analyses of the same or overlapping study cohorts and were therefore not considered independent replications. Results: The included studies comprised observational studies and exercise intervention trials involving healthy individuals and clinical populations. Retinal biomarkers assessed included vessel diameters, arteriovenous ratio (AVR), vessel density, perfusion density, foveal avascular zone (FAZ), retinal oxygen extraction, wall-to-lumen ratio (WLR), and choriocapillaris perfusion parameters. Several studies reported measurable acute and chronic retinal vascular responses to exercise, although the direction, magnitude, and clinical meaning of these changes varied according to population, exercise modality, imaging technique, and biomarker. Observational studies generally reported associations between higher physical activity or cardiorespiratory fitness and a more favorable retinal vascular profile, but causal interpretation remains limited. Conclusions: Retinal microvascular biomarkers appear sensitive to acute physiological stress and may reflect selected adaptations associated with longer-term exercise exposure. However, retinal responses are heterogeneous and biomarker-specific, and their biological and clinical significance remains incompletely established. Methodological heterogeneity, overlapping study cohorts, and the limited number of adequately powered randomized and longitudinal studies constrain causal interpretation and generalizability. Retinal vascular measures should therefore currently be regarded as candidate biomarkers and research tools rather than validated surrogate outcomes or routine clinical measures. Full article

Background: Fragrance-free policies are increasingly adopted to improve indoor air quality and reduce fragrance exposure linked to adverse health outcomes and accessibility barriers. This scoping review mapped the evidence on fragrance-free policies across sectors. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched five peer-reviewed databases and grey literature sources. Documents describing formal scent-free or fragrance-free policies or guidance in workplaces, healthcare, educational, or public settings were included. Data were charted on policy characteristics, enforcement mechanisms, implementation supports, and governance features. Results: Sixty-three documents were included. Findings revealed substantial variability in terminology, scope, and enforcement. Many policies relied on voluntary compliance and awareness-based strategies, with limited integration of structural supports such as procurement controls, staff training, and evaluation frameworks. Enforcement mechanisms were predominantly reactive, responsibilities were inconsistently defined, and consequences for non-compliance were limited. Although many policies referenced multiple chemical sensitivity or fragrance sensitivity, accommodation pathways and accountability structures were frequently lacking. Four key themes indicate that many fragrance-free policies function as accommodation tools rather than integrated environmental health interventions. Conclusions: Strengthening definitional clarity, institutional accountability, and structural integration may enhance effectiveness and support more consistent, equitable, and evidence-informed approaches to reducing fragrance-related exposures in indoor environments. Full article