Importance Few studies have examined the relationship between nonmalignant chronic pain (NMCP) and suicide death, and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death. Objective To assess whether sleep disturbance mediates the relationship between NMCP and suicide death. Design This case‐control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls). Setting Eight Mental Health Research Network (MHRN)‐affiliated healthcare systems. Participants All cases and matched controls were health plan members for at least 10 months during the year prior to the index date. Main Outcomes and Measures Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)‐10 codes from official government mortality records matched to health system records. Results After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model. Conclusions and Relevance There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP.

The community readiness model (CRM) was used to assess changes in community readiness across four counties in Georgia that were targeted as part of a 3-year Childhood Obesity Prevention Program. Key respondent interviews were conducted with community stakeholders in 2012 (n = 20) and 2017 (n = 18) using a semistructured questionnaire assessing six dimensions of community readiness (i.e., community efforts, community knowledge of efforts, leadership, community climate, community knowledge about the issue, and resources available to support efforts). Interviews were analyzed using the CRM scoring protocol and qualitative methods. Paired t tests were used to compare mean score differences between baseline and follow-up assessments. At baseline, overall mean readiness scores for the four counties ranged from 4.52 to 5.05 on the CRM 9-point scale. At follow-up, overall readiness scores ranged from 6.01 to 6.97 out of 9.00. Data revealed a statistically significant improvement in scores across all communities (+1.70, p = .007; 95% confidence interval [0.87, 2.51]). Data also revealed statistically significant improvements in every dimension of readiness, except community knowledge of the issue. Information gleaned from interviews suggested that investing in staff to support efforts, building awareness to shift the community climate, and cross sector collaboration contributed to improved community readiness among the study communities. The provision of technical assistance, peer learning opportunities, and financial support as part of a cooperative grant initiative holds promise for increasing the capacity of community coalitions to advance childhood obesity prevention efforts in their local communities.

Background In sub-Saharan Africa, there is dearth of trained laboratorians and strengthened laboratory systems to provide adequate and quality laboratory services for enhanced HIV control. In response to this challenge, in 2007, the African Centre for Integrated Laboratory Training (ACILT) was established in South Africa with a mission to train staffs from countries with high burdens of diseases in skills needed to strengthen sustainable laboratory systems. This study was undertaken to assess the transference of newly gained knowledge and skills to other laboratory staff, and to identify enabling and obstructive factors to their implementation. Methods We used Kirkpatrick model to determine training effectiveness by assessing the transference of newly gained knowledge and skills to participant’s work environment, along with measuring enabling and obstructive factors. In addition to regular course evaluations at ACILT (pre and post training), in 2015 we sent e-questionnaires to 867 participants in 43 countries for course participation between 2008 and 2014. Diagnostics courses included Viral Load, and systems strengthening included strategic planning and Biosafety and Biosecurity. SAS v9.44 and Excel were used to analyze retrospective de-identified data collected at six months pre and post-training. Results Of the 867 participants, 203 (23.4%) responded and reported average improvements in accuracy and timeliness in Viral Load programs and to systems strengthening. For Viral Load testing, frequency of corrective action for unsatisfactory proficiency scores improved from 57 to 91%, testing error rates reduced from 12.9% to 4.9%; 88% responders contributed to the first national strategic plan development and 91% developed strategies to mitigate biosafety risks in their institutions. Key enabling factors were team and management support, and key obstructive factors included insufficient resources and staff’s resistance to change. Conclusions Training at ACILT had a documented positive impact on strengthening the laboratory capacity and laboratory workforce and substantial cost savings. ACILT’s investment produced a multiplier effect whereby national laboratory systems, personnel and leadership reaped training benefits. This laboratory training centre with a global clientele contributed to improve existing laboratory services, systems and networks for the HIV epidemic and is now being leveraged for COVID-19 testing that has infected 41,332,899 people globally.