Am J Infect Control. 2026 Sep 1:S0196-6553(26)00680-2. doi: 10.1016/j.ajic.2026.08.019. Online ahead of print.

ABSTRACT

BACKGROUND: Despite high infection risk among home healthcare (HHC) patients, little is known about home environmental conditions that may affect infection prevention and control (IPC).

METHODS: We conducted a cross-sectional study of 250 HHC patients and caregivers from two Medicare-certified agencies. In-home surveys and structured observations assessed household hazards, and, in more detail, cleanliness and clutter. Multivariate linear regression examined associations between home environment and sociodemographic, clinical, and community factors.

RESULTS: On average, at least one household hazard was observed; poor lighting and clutter were the most common, followed by infestation. Homes were predominantly assessed as mostly clean but exhibited moderate clutter. Older age, being Hispanic, and more favorable IPC attitudes were associated with greater cleanliness. Difficulty paying medical bills was associated with higher clutter scores. High neighborhood deprivation was associated with lower clutter scores.

DISCUSSION: Although homes were mostly clean, clutter and hazards were common and may impede IPC practices. Individual-level factors, particularly difficulty paying medical bills and attitudes towards the home environment, were most strongly associated with home environmental conditions.

CONCLUSIONS: Incorporating structured home environment assessments into HHC practice may help identify modifiable barriers to IPC and inform targeted interventions in home-based care.

PMID:42679900 | DOI:10.1016/j.ajic.2026.08.019

J Pain Symptom Manage. 2026 Aug 19:S0885-3924(26)00954-1. doi: 10.1016/j.jpainsymman.2026.08.011. Online ahead of print.

ABSTRACT

CONTEXT: Hospice and palliative medicine (HPM) clinicians increasingly care for patients with serious illness and prolonged opioid exposure, yet often report limited training managing consequences like opioid misuse or opioid use disorder (OUD). Little is known about core addiction skills training in HPM physician fellowships.

OBJECTIVES: To describe current training in core addiction skills for HPM fellows, identify barriers to curricular expansion, and characterize fellowship program director (PD) perspectives and priorities.

METHODS: Cross-sectional national survey of PDs from ACGME-accredited HPM fellowships in the United States assessing core addiction skills training, PD perspectives, and curricular challenges and priorities.

RESULTS: Of 160 eligible programs, 79 PDs responded (49.4%). Most PDs rated addiction training as highly relevant (86%) and important (75%) to HPM practice. PDs perceived that fellows have low confidence with opioid misuse or OUD, despite commonly encountering such patients. Most programs offered limited training (2-3 hours), though many provided electives. Fewer than 20% of programs had faculty with formal addiction training, and 25% reported no faculty with buprenorphine experience. The most frequently cited barriers to curricular expansion were limited faculty expertise in addiction and buprenorphine, and competing curricular priorities. While foundational skills were commonly addressed, PDs identified curricular development priorities including: buprenorphine use, pain management in OUD, and motivational interviewing.

CONCLUSION: Despite broad recognition of the importance of core addiction skills, a shortage of faculty expertise constrains education in HPM physician fellowships. Scalable, technology-enabled, shared curricular approaches may help expand access to expertise and better align training with clinical demands.

PMID:42617988 | DOI:10.1016/j.jpainsymman.2026.08.011

Pregnancy (Hoboken). 2026 Mar 22;2(2):e70274. doi: 10.1002/pmf2.70274. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: The emergence of xylazine, a veterinary alpha-2 and kappa opioid receptor agonist, as an adulterant in illicitly manufactured fentanyl has created new challenges and risks for pregnant people who use unregulated opioids. Xylazine test strips (XTSs) have been proposed as a harm reduction strategy, but their use has not been studied among pregnant and postpartum populations. The goals of this study were to assess the feasibility, acceptability, and efficacy of a novel Perinatal XTS intervention aimed at reducing xylazine exposure and associated harms.

METHODS: Pregnant and postpartum women with opioid use disorder and high risk of ongoing unregulated opioid use were recruited from inpatient units of a high-volume maternity hospital in western Pennsylvania. Participants engaged in a standardized educational session about xylazine and XTS and then were given five XTS kits. Over a 2-month period, participants were asked to complete a real-time survey when they used an XTS to report test results and any associated drug use behavior change. All participants were asked to participate in an end-of-study survey and a semi-structured interview about their experiences with Perinatal XTS.

RESULTS: A total of 50 participants were enrolled, completed the education session, and accepted the XTS kits. Most participants were concerned about the potential impacts of xylazine on pregnancy and neonatal outcomes. Seventeen participants submitted a total of 71 real-time surveys after using XTS to test drug samples. In the majority of cases, a positive result prompted behavioral change. Qualitative interviews with participants revealed six major themes: (1) Xylazine and XTS education was highly acceptable. (2) Desire for additional education related to xylazine. (3) XTS distribution and use were highly acceptable. (4) Impact of XTS on behavior change varied based on participant circumstances. (5) Concerns related to xylazine’s impact on maternal health and treatment. (6) Concerns related to xylazine’s impact on fetal and neonatal health.

CONCLUSION: Findings from this pilot study demonstrate that Perinatal XTS, a harm-reduction intervention combining xylazine and XTS education and XTS kit distribution, is highly feasible to deliver, is acceptable among pregnant and postpartum women cared for in an obstetric healthcare setting, and has the potential to reduce risk-related behaviors.

PMID:42596917 | PMC:PMC13344234 | DOI:10.1002/pmf2.70274

JAMA Intern Med. 2026 Aug 10. doi: 10.1001/jamainternmed.2026.3788. Online ahead of print.

NO ABSTRACT

PMID:42574008 | DOI:10.1001/jamainternmed.2026.3788

Psychiatr Serv. 2026 Aug 6. doi: 10.1176/appi.ps.20250157. Online ahead of print.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic exacerbated health disparities and increased alcohol use and its health consequences. Although prepandemic research identified racial and ethnic disparities in receipt of alcohol use disorder treatment, few studies have described postpandemic disparities or have assessed the role social determinants of health (SDOHs) may play in these inequities. The authors examined how rates of treatment for alcohol use disorder differ by race and ethnicity, SDOHs, and at the intersection of both.

METHODS: In this cross-sectional analysis, the authors used a nationally representative sample of 5,785 U.S. adults with past-year alcohol use disorder from the 2023 National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression models were used to estimate the probability of any past-year alcohol use disorder treatment overall, by the intersection of race and ethnicity with 20 SDOH subcategories, and across treatment settings.

RESULTS: Only 9.6% of adults with alcohol use disorder in the NSDUH received any treatment in 2023. Compared with other racial and ethnic groups, non-Hispanic Black or African American adults had the lowest probability of receiving treatment for alcohol use disorder overall and in the stratified analyses of nine of 20 SDOH subcategories.

CONCLUSIONS: These findings highlight significant disparities in the receipt of treatment for alcohol use disorder among non-Hispanic Black or African American adults, generally concentrated within the more vulnerable SDOH categories. These results underscore a critical need for clinically and culturally nuanced policies and practices tailored to specific populations with health disparities.

PMID:42557603 | DOI:10.1176/appi.ps.20250157

Am J Prev Med. 2026 Jul 30:108537. doi: 10.1016/j.amepre.2026.108537. Online ahead of print.

ABSTRACT

INTRODUCTION: A 2019 Medicare opioid safety policy limited initial opioid duration to 7 days and long-term daily dosage to 90 morphine milligram equivalence (MME). Because effective pain management may vary by rurality, this study examined whether the policy differentially affected opioid prescribing among rural versus urban beneficiaries with disabilities.

METHODS: Deidentified claims data was used to gather a rolling cohort of Medicare Advantage beneficiaries with disabilities ages 18 to 64 from 2016 to 2021. Comparative interrupted time series were used in 2025 to analyze rural-urban differences in the duration and dosages of opioid fills for new-to-opioid beneficiaries, the target of the 7-day limit (N = 526,019 person-months), and the number of high-dosage episodes for long-term opioid beneficiaries, the target of the 90-MME limit (N = 3,312,161 person-months).

RESULTS: Despite significant reductions in initial opioid duration for both groups, the 7-day limit effect on initial opioid duration weakened over time (trend change: 0.17 [98.75% CI 0.04 to 0.30]) in the rural relative to the urban group. By the end of the study period, the rural group experienced 3.8 percentage points more initial opioid fills exceeding the 7-day limit (95% CI 0.4 to 7.3) than the urban group. Furthermore, the total dosage prescribed in subsequent fills among rural beneficiaries was 27.97 MME (95% CI -52.19 to -3.75) less than urban beneficiaries by the end of the study period. The rural and urban groups responded similarly to the 90-MME limitation.

CONCLUSIONS: Rural relative to urban new-to-opioid beneficiaries with disabilities experienced a weakened effect on initial opioid duration after Medicare’s 7-day limit, while receiving declining dosage in follow-up opioid fills, suggesting potential disparities in access to follow-up opioid prescriptions for rural versus urban beneficiaries with disabilities. Policymakers may consider more flexible opioid regulations and attention to alternative pain management for rural Medicare beneficiaries.

PMID:42532454 | DOI:10.1016/j.amepre.2026.108537