The subject of the current study is the process of implementing the social housing policy and its impact on increasing the quality of life (QOL) of vulnerable people. The analysis is related to the Social Housing Program introduced by the city of Gdańsk (Poland). The study has been carried out using the case study method with the use of document analysis, analysis of existing data, and five in-depth interviews with program managers. The theoretical framework has been developed around three major explicatory perspectives: multi-level governance (MLG), QOL, and social exclusion. Meeting the housing needs is one of the primary tasks of local governments. If such a policy is to be called positive, it should be combined with social policy tasks related to social inclusion, and it should be carried out through partnerships forming housing cooperation networks. A characteristic feature of the cooperation is the cross-sectoral nature of the actors. The results have revealed a significant positive relationship between the use of social housing tools and the quality of satisfying the living needs of the residents. This study contributes to the discussion by revealing the role of social work and social and professional activation in meeting housing needs. The results suggest that a combination of housing and social policy measures can help vulnerable people develop social competencies conducive to housing maintenance and increase the social cohesion of local environments. Living space is a basic condition for running a household and a family life. By satisfying basic human needs, it fulfills many other functions simultaneously: improving quality of life (QOL), increasing motivation for social activities, supporting intellectual development, minimizing frustration, and building a sense of security. It is one of the fundamental factors in making decisions about starting a family . ResearcHowever, housing is costly, especially for low-income people. In this situation, the exclusion does not only include physical problems with the apartment (the roof over the head) but also issues with establishing social relationships and problems with administrative and legal regulations . This viEven if existing methods of managing housing resources in communities were supposed to counteract the above situation, they did not bring about positive changes. People at risk of social exclusion and with lower social competencies could not maintain their apartments and care for their condition . The locAs far as setting priorities in terms of the objectives of social housing policy is concerned, the approach of the European Federation of National Organizations Working for Homeless People FEANTSA  should bMeanwhile, a permanent principle of an ineffective social housing policy is to place people in need in care institutions and other institutional forms of housing that strongly reduces residents’ QOL. Research on homelessness and social exclusion show the following relationship—the longer people remain homeless, the more complex is their process of reintegration into society. According to experts, people exposed to a lack of home receive too little state aid, often limited to the allocation of temporary shelter, which becomes the final solution after some time and causes social exclusion . The priThe implementation of the above objectives of state policy requires specific instruments regarding people with low economic status or special social groups described as vulnerable or in need . These iMulti-level governance is concerned with decision-making procedures and the regulation of political negotiation processes. Its characteristic feature is the extension of the typical hierarchical course of the decision-making process with nonhierarchical elements. To achieve this, public institutions involve entities representing all sectors: public, non-governmental, and private  in the dSeveral studies have provided empirical evidence for the relationship between trust and multi-level collaboration. Institutional trust allows for the implementation of common goals  because Quality of life is the degree to which an individual is healthy, comfortable, able to participate in or benefit from life events. It is an integrated system of motivational and aspirational factors, the basis of which are the needs and values of an individual . The staConcerning having housing resources, an important determinant of well-being is developing a sense of place affect. Place effect has been defined as the affective bond that connects individuals with the environment and promotes psychological restorativeness . Some evThe present study performs an in-depth analysis of the implementation of the Gdańsk Social Housing Program for 2016–2023 . The Program has been running since 2016. Over 100 people representing about 40 organizations participated in its development. The Program leader and manager of the developed housing policy were the Social Development Department of the Gdańsk City Council. The basic issues discussed in the article refer to three areas: program structure, principles of its implementation, and its effects, with particular emphasis on changes in the quality of life of the participants. It is also important to assess the impact of the applied MLG on shaping public policy. At this point, the thesis is that the GSHP is a stable set of interdependent entities representing the public, private, and social sectors, which implements the principles of the deinstitutionalization process and MLG with the application of stable cooperation patterns, concentrated around needs and social problems within the implementation of public policy. This results in permanent social changes and an increase in the quality of life of the inhabitants.The present analysis is based on GSHP research with the application of three methods: document analysis, analysis of existing data, and unstructured interviews. The rationale for choosing such a source was: (1) the availability of information about the Program and projects implemented within this framework on websites and (2) the possibility of accessing statistical data obtained by the city council and the organizations cooperating with it on the relevance of the solutions used in the Program and meeting the needs of residents. The analysis of the documents included: (1) legal acts and strategic documents related to GSHP implementation,The construction of the Program defined the direction for the search for participants in unstructured interviews. In total, five interviews were conducted with persons representing the four basic institutions of the Program: (1) Social Development Department, (2) Municipal Services Department of the Gdańsk City Council, (3) Municipal Family Support Centre in Gdańsk, and (4) representative of social organizations—Gdańsk Social Innovation Foundation. We conducted the fifth interview with a representative of the Program management group. The respondents were aged 35–50 (three men and two women). The selection criterion was the knowledge of the Program operation and experience in implementing its tasks. The interviewees worked on the development and implementation of the Program and were identified by the organizations surveyed as people with the deepest knowledge of it. The collected information concerned mainly the principles of the Program implementation, partnership cooperation, decision-making methods, as well as ways of working with program participants and obtaining feedback on the residents’ satisfaction with the results.Based on the interviews, qualitative data analysis was performed. The analytical process of the collected data from the interviews included three stages: data reduction, data display, and the derivation/confirmation of conclusions. In the transcripts of the interviews, we searched for meaningful concepts and key events. We also performed a repeated reconstruction of the text until the connections between the topics selected for analysis were revealed . Audio rThe GSHP combines solutions in housing policy with solutions in integration and social assistance, and due to this collaboration, two models of housing have been developed in the local municipal law: supported housing and assisted housing schemes. Although the former has a well-established position in Polish legislation, the latter is a novelty. Its task is to increase the effectiveness of the management of housing resources in the commune and to improve the quality of life of its participants . The main principles of the program operation are presented in This Program primarily targets people and families threatened with difficulties. The solutions used in GSHP combine housing assistance with the support of a psychologist, lawyer, social worker, or educator in solving everyday life problems. The mechanism of functioning of the Program is as follows: municipal housing services secure the number and quality of housing planned in the Program for people or families in need, and municipal social services provide support to those people or families to reintegrate into society and regain independence in life. This systemic cooperation in housing policy and social policy is also intended to ensure better performance of residents in their responsibilities to care for municipal buildings and to pay rent. “Previously, there was not enough cooperation in council housing, helping to leave the support system after training. And if we managed to get the housing that these people needed, we often had such a problem that these people owed them. Hence, we need to come up with a solution that will be a transition stage between a supported house and a typical council flat. We came up with a program that we called ‘houses with assistance” (I2).However, the most crucial task of the Program is to create a chance for many vulnerable people and families to function in an intimate environment rather than in the environment of the appropriate institutions. In this way, the principle of deinstitutionalization of social services is fulfilled. Due to this solution, according to one of the interviewees, “finding an assisted apartment almost overnight in a challenging situation is possible” (I2).The Program is structured in three stages, with the participant being able to move from supported housing, through housing with assistance, and council housing accessible to all residents who meet the income criterion. The connections between these stages are shown in The Program’s activities are aimed at adults who cannot overcome their housing problems with their available resources and possibilities. They are vulnerable people, such as young people growing up in difficult conditions without the support of their parents, people with special needs and disabilities, people at risk of eviction or experiencing homelessness or recovering from addictions, but also victims of domestic violence or random events or traumatic events. Among vulnerable people, there are also people with low professional qualifications, the elderly and lonely, immigrants and national minorities.The implementation of GSHP is based on the principles of cooperation, human dignity, flexibility in the actions taken, trust, and continuous education.During both the stages of the development of the GSHP and its implementation, the emphasis is placed on cross-sectoral cooperation and 95% of the tasks in the Program have been assigned to social organizations, which are responsible for implementing social work, social and professional management, psychological support, or additional social assistance. NGO trainers are also lead trainers who contact program participants, assess their needs, and perform their tasks. It should be noted that not all jobs are commissioned by the community, as some of them appear as the own initiative of social organizations (I2). Similar cooperation affects the recruitment of participants to the Program. “We have very partnership cooperation here. If in our opinion one of our proteges is suitable for living in one of the Municipal Family Support Centre apartments, they do not say no, and if they have another person for this place, we discuss which option will be better” (I1).The support provided under the Program is individualized, which is ensured by the diversity of organizations that cooperate with the city and their specialization. Currently (2021), 20 organizations deal with a wide range of social problems. The techniques used to work with residents are also important. The basic rule is to diagnose the participants when they enter the Program. The diagnosis is based on the individual’s goals and not on the shortcomings. It is a concept that derives from idea of nonviolent understanding of The second important rule is to provide residents with as many hours of support as they need. If the person studies or works and does not require constant approval, meetings are held once a month. If she/he has more significant needs, the trainer will meet her/him more often. According to the representative of the foundation who participated in the research, this support should never be provided in an apartment. “In typical (highly functioning) families, the psychologist does not visit their home” (I1). The type of support is also adjusted to the needs of the residents. This is the only way to increase the sense of security and quality of life. The analysis done by the foundation reveals that residents who cooperate with it describe maintaining independence and safety as their basic needs, and meeting them requires different methods. There is always the issue of effective budget management and the principle that the rent is to be paid regularly.In its work, the foundation has adopted a model of the person-centered approach. “We are working on very different things. Some people need to be safe, and they need a lower rent, and that is okay for us. Some people do not fully know what opportunities and prospects are good for them, and we talk about it with their consent. This is one piece. However, some people are in a deep crisis. They come out of violence, from diseases , and here, the work is more intense. We then cooperate with the Municipal Family Support Centre and we make sure that this person has a family assistant, a social worker” (I1). Due to the diversity of organizations working in the Program, this is not the only rule.The implementation of the Program started in 2016. At that time, the city’s resources included 147 places (flats/rooms) in various forms of support . At the end of 2020, GSHP had 70 supported places operating under 14 projects with 254 people benefitting from this part of the Program. There were 105 apartments with assistance in five projects, including 48 temporary accommodations at the Social Skills Training Centre. In total, in 2020, 143 people used assisted housing scheme. The analyses conducted by the Gdańsk Social Innovation Foundation show a clear improvement in the social competencies of its proteges and an increase in the quality of life. Since 2016, 55 people have benefited from its help, 28 foster children, 13 partners/spouses, and 14 children. Around 15 people have already left assisted housing, seven of them having obtained apartments from community resources. Five people have rented apartments on the open market. However, three people have chosen their private path and do not want to stay in touch with the foundation (I1).The foundation’s data show that 100% of people starting work in social enterprises and using assisted rental left the Program and are doing well on the open housing and labor market (I1). This is a significant finding indicating the development of good practice and it indicates the increase of the effectiveness of housing support when combined with supported employment. Currently (2021), 23 out of 28 residents are long-term workers with the rest studying, caring for children, or having limited employment possibilities due to health difficulties. Among all people working long-term (under the foundation’s care since 2016), seven were promoted to a higher position, seven achieved stabilized employment (transition from contract to full-time work), three people started their own company. Of all these people, 10 participated in work in social companies run by the foundation (I1).Another important success of the Program is the security of residents in the COVID-19 pandemic. As a result of the complicated situation in the local labor markets, some residents began to fall behind on rents. The Program’s employees provided such families with additional support, spread their repayments into installments, or canceled the debts. Furthermore, it turned out that the feeling of loneliness, common in the pandemic, was not noticed in the groups sharing apartments (three-person apartments for young people participating in the Program).The pandemic, however, made it very difficult to implement one of the younger projects at GSHP—the Housing First project. Its goal is to support the homeless. Its principle is to provide an apartment first and then to implement social work. According to one interviewee, the confinement of people experiencing homelessness in their apartments due to lockdown was like imprisonment, which resulted in difficulties in maintaining housing stability and returning these people to life on the street (I2). The Housing First project led to the additional discovery. Thanks to its implementation, it was noticed that some people in the crisis of homelessness, staying in nonresidential places, are people with intellectual disabilities. It was a surprise both for the Program implementers and the organization supporting the city in terms of the theme of the Housing First project: Entrada—AEIPS – Associação para o Estudo e Integração Psicossocial (I2). The low effectiveness of the support system for people with disabilities in Poland poses an additional challenge in working with these people in this Program.The subject of the study was the implementation of a social housing policy by the city of Gdańsk. Using the case study method, we are analyzed its structure and performance principles, looking for its strengths, weaknesses, and good practices.The findings revealed that both program development and management are cross-sectoral. Several institutions and several dozen organizations are involved in implementing the Program and fulfilling their tasks, they draw on their knowledge and experience at the same time applying the principles of their own organizational cultures . This meThe results also showed that the Program team is creating a self-learning system that is about establishing patterns of behavior, replicating them, and adjusting them to the needs of the inhabitants. The knowledge generated by its participants is transferred as part of cooperation and a diverse team allows creating new interpretations of the information obtained, which leads to the development of the applied methods of operation and the increase of the adequacy of support . This fiOrganizations cooperating in the Program show a fundamental similarity , facilitating cooperation. Furthermore, research on MLG emphasized the similarity of organizations connected by this type of cooperation. The feature that brings organizations closer together is, primarily, their type, which is closely related to the legal and organizational framework that determines the ways and scope of their activities . Their dFinally, our findings display the program’s effectiveness in increasing the quality of life of its participants. Data on objective welfare criteria (limiting housing deprivation) collected by the Social Development Department of the Gdańsk City Council and the Gdańsk Social Innovation Foundation prove it. In everyday life, participants of the Program develop social competencies, recover from inter and intrapersonal crises, and create positive social relations. According to the literature, there is an increase in QOL also in relation to subjective criteria . EvidencHowever, the experiences of the homeless do not confirm these findings. They rather concern people in a crisis of loneliness, such as people with disabilities, the long-term sick, or the elderly. Confinement in apartments (as consequence of the spread of the COVID-19 virus) resulted in a decrease in the quality of life in relation to the fulfillment of the need for self-reliance, independence, and self-control among homeless participants of the Program. Being confined during epidemics brought a sense of isolation and emotional distress . The litParticipation in GSHP increases professional activity and, above all, meets the basic need for security, related to the constant possession of a flat . MoreoveAdditionally, the practice of providing social differentiation within settlements is a good move to ensure that the risk of social exclusion for their citizens is reduced. The results of the study indicate that the introduction of a criterion for the management of social housing resources in a commune, concerning the creation of flats and estates scattered throughout the city, is aimed at limiting the emergence of poor or homogeneous districts, e.g., ethnically, racially, threatened with social exclusion and degradation, which additionally increases the quality of life of their inhabitants and prevents exclusion . Older pThe Program also has its limitations. Difficulties in cooperation between residents and trainers or social workers constitute a barrier to the implementation of the goals and tasks of social housing in the commune. Some of the inhabitants of supported flats declare that they do not see the possibility of cooperation with anyone from the Program because the participation results in constant monitoring of their activities, or the progress interferes with their privacy and life. As a result, they lose the possibility to use the apartments. Another barrier is related to the monitoring and evaluation of GSHP. The variety of organizations implementing the Program leads to reporting different and sometimes incomparable data. In the evaluation of the program implementation, no unified tools have been developed so far for measuring the achievements of the organizations implementing. There is also a need for unified tools for assessing the progress of residents  and minimal standardization of the applied work methods. A third of the barriers to GSHP operation are the challenges related to achieving the indicator—50 apartments, annually allocated to the Program. It is caused by the difficulties in finding external financing sources for housing investments and the incorporated support programs. The Program, first, needs small apartments because the largest group of participants are people who run one-person households. However, this situation should change as more municipal investments will provide apartments in 2022–2023.Nevertheless, some limitations of the present study should be considered. Firstly, the presented results concerning the assessment of the quality of life were formulated from the program implementers’ perspective. Their basis was the assessment of its effectiveness and the satisfaction of the residents’ needs. The analyses of the Program participants’ opinions on changes in their quality of life come from the research of the Gdańsk Social Innovation Foundation. This also applies to detailed data on the social and reintegration successes of the inhabitants. Future research should accept the stand of the residents cooperating with other program implementers to a greater extent. Gdańsk Social Innovation Foundation is a large organization that reasonably represents the NGOs operating in the Program. Nevertheless, to obtain full knowledge about the effectiveness of the implemented social support, it is worth measuring the achievements of other organizations performing the task. Additionally, the use of standardized tools for this purpose will provide the possibility of inter-organizational comparisons. The second reservation is related to the above. Quality of life analysis concerned the assessment of objective well-being criteria. It is worth expanding this research with subjective criteria that program participants could provide.Gdańsk Social Housing Program combines solutions in the field of housing and social policy on an unprecedented scale. The solution concerning the introduction of the housing with support model is precious. In Poland, “flats with assistance” are a novelty. It is a type of housing where full daily support is not provided. Meetings depend on the needs of residents and concern budget management, becoming independent, help in finding a job, and psychological support in difficult situations. The idea is to support residents in paying their rent regularly and taking care of the apartment’s condition. This solution protects the inhabitants against the loss of flats and housing resources, devastation, and debts . It has However, thoughtful planning of the Program implementation in the coming years will require the development of further strategies. It is about involving new organizations implementing the Program and extending its impact to new categories of people who need housing. A harmonious relationship between residents, places, community organizations, and local government can promote sustainable social development and contribute to sustainable housing development . It willThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.The author confirms being the sole contributor of this work and has approved it for publication.This work was supported by the Institute of Sociology of the University of Zielona Góra, Poland.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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Since 2011, the Demographic and Health Surveys (DHS) Faculty Fellows Program has strengthened individual skills in conducting research with data from large surveys and increased institutional capacity to analyze DHS data through fellows' capacity-building activities at their home universities. The lessons learned can inform models for strengthening capacity in analyzing and using data in low- and middle-income countries. The Demographic and Health Surveys (DHS) Faculty Fellows Program has trained 152 researchers from 45 universities in 25 countries in Africa, Asia, and the Middle East—demonstrating that it is possible to improve research and analysis skills in low- and middle-income countries through a short-term targeted program.The program has not only strengthened individual skills in conducting research with data from large surveys but also substantially increased institutional capacity to use and analyze complex survey data through the fellows' cascading of capacity-strengthening activities at their home universities.Continued investment is needed to strengthen the countries' capacity to use complex survey data for their policy and program purposes.The DHS Faculty Fellows Program provides a successful model that other international development programs can use to strengthen capacity in analysis and use of data in low- and middle-income countries.Capacity-strengthening programs should engage local institutions to be more effective and sustainable. Primarily funded by the United States Agency for International Development (USAID), the Demographic and Health Surveys (DHS) Faculty Fellows Program is designed to strengthen the institutional capacity of universities in low- and middle-income countries to use and analyze DHS data. This article provides an overview of the program's evolution and its current form; presents successes and impacts; and discusses challenges, lessons learned, and potential further directions.Initiated in 2008, the Fellows Program underwent several rounds of improvement. The current model involves a competitive team application process, 2 intensive in-person workshops, completion of a working paper of publishable quality, and the transfer of analysis skills learned during the fellowship to students and colleagues at home universities, all completed over 1 year. Since 2011, the Fellows Program has trained 152 researchers from 45 universities in 25 countries in Africa, Asia, and the Middle East. The program has not only strengthened individual skills in conducting research with data from large surveys but also substantially increased institutional capacity to analyze DHS data through fellows' capacity-building activities at their home universities. These successes have happened despite the many and continuing challenges related to fellows' diverse backgrounds, experience, skills, language barriers, logistical difficulties in organizing in-person workshops in fellows' countries, and sometimes fellows' varying levels of commitment.With continuous support from USAID, the program hopes to expand to more universities and countries, especially francophone countries. Overall, the DHS Faculty Fellows Program has proven to be highly successful and provides a model for other groups aiming to strengthen capacity for data use and research in low- and middle-income countries. The Demographic and Health Surveys (DHS) Program is a United States Agency for International Development (USAID)-funded project that assists low- and middle-income countries with the implementation of nationally representative household surveys that collect data on population, health, and nutrition and with the analysis and dissemination of these data. Since 1984, the DHS Program has implemented more than 400 surveys in 90 countries and is a major source of reliable data that inform national and international population and health policies and programs. In addition to technical assistance in data collection, the DHS Program is committed to strengthening the capacity of host-country partners all along the survey continuum, from survey and sample design to data analysis, dissemination, and use. The DHS Faculty Fellows Program is a major component of the DHS Program's long-standing commitment to increasing host-country capacity to use DHS data. Its primary objective is to strengthen the institutional capacity of universities in participating countries to understand the DHS microdata and use them to conduct complex analyses to answer policy- and program-relevant questions. The DHS Faculty Fellows Program seeks to create sustainable in-country capacity by training university faculty whose role is to educate students who will be the country's future policy makers, program managers, and researchers. Although the Fellows Program trains individuals, 2 key elements help to cascade the learning to the fellows' home universities. First, individual faculty are enrolled in the program as a team with other faculty from the same university, allowing for reinforcement of learning. Second, the terms of the Fellows Program require that on completion, the trained faculty will implement self-designed activities to transfer their learning to others within the university. To ensure institutional commitment to these program requirements, fellows' applications must include evidence of permission from their university authorities.This article provides an overview of the program's evolution; describes its current form; presents successes and impacts; and discusses challenges, lessons learned, and potential further directions. The DHS Faculty Fellows Program provides a valuable model for strengthening capacity for data analysis and research in low- and middle-income countries. Experience and lessons gained from this program could also inform global capacity-strengthening programs in areas beyond research and data analysis.The DHS Fellows Program originated in 2008 and went through several major shifts in the course of its development .The original DHS Fellows Program was designed to focus on building individual skills to prepare academic papers based on DHS data. The first 2 rounds of the Fellows Program, in 2008–2009 and 2009–2010, included a competitive application process, with a journal-quality research paper as the final deliverable, mentoring of each participant by a member of the DHS technical staff, and a US workshop. Although it was open to qualified candidates from any country, the applicants were primarily graduate students and junior faculty from US and European universities. Fellows received remote guidance and support, mainly from their DHS mentor, on formulating research questions, analyzing data, preparing an analysis plan, and writing the final paper. Toward the end of each round, all fellows came to the DHS headquarters in Maryland, USA, for a 2-week workshop, during which they received intensive one-on-one assistance from their mentors and other DHS staff to finalize their research papers.The first 2 rounds successfully trained many researchers and provided valuable lessons for future rounds of the program. Participant feedback emphasized the need for an additional workshop at the beginning of the program, which would provide more formal training on the fundamentals and correct use of DHS data before fellows began their own analysis. Two workshops could maximize the learning experience and facilitate the production of high-quality papers. Although these rounds of the program included some participants from low- and middle-income countries, there was no exclusive focus on these countries where there is a great need and a high demand for capacity strengthening in data analysis and use.Based on the lessons from the first 2 rounds and the recognition that the format did not fulfill the DHS Program mandate to build capacity in DHS host-countries, the Fellows Program was completely redesigned in 2011 to target universities in low- and middle-income countries. In this iteration, the program focused specifically on junior faculty, who would have many years to train students and contribute to their institutions. In this round, DHS limited the call for applications to several East African countries that had implemented multiple rounds of DHS surveys. Two workshops were provided for the participants: the first was early in the fellowship to provide a solid foundation for DHS data use and instruction, and the second was several months later, allowing sufficient time for fellows to work on their research papers. The first workshop was held in Kenya that year and the second at DHS headquarters. The 2011 program represented 10 universities in 6 East African countries. Most fellows successfully completed a paper that was subsequently published in the DHS Working Paper series.Although the first 2 rounds of the DHS Fellows Program trained many researchers, the program was redesigned in 2011 to focus on university faculty in DHS host-countries.Although the 2011 round of the program did consider institutional capacity building—for example, by focusing on junior faculty who may have many years to “give back” to their universities—it was not until the 2012 round that institutional capacity strengthening became a key focus of the program. One modification to this end was to replace applications from individuals with applications from 3-person teams from the same university. The 3-member faculty teams were expected to work together to develop their research proposal, complete a research paper, and develop and implement a capacity-building plan for their home universities. This modified approach was aimed at helping increase institutional capacity in data analysis and research through training more than 1 faculty at a time so that team members could reinforce the learning, and by requiring that the training be cascaded to other faculty and students in each participating university. To ensure successful implementation of the capacity-strengthening plan at the home universities, each team was required to include a senior faculty member who would likely have a greater influence on curriculum development and research activities in the department.For the first few years, the program primarily focused on countries in sub-Saharan Africa, but in 2017 it was expanded to Asia and the Middle East. The expansion to these regions was motivated by DHS statistics on the number of DHS datasets downloaded by country that indicated limited requests for and use of DHS data in these regions (except for India), despite the availability of multiple surveys in many countries. In addition, analysis of data from DHS's tracking of journal articles using DHS data also showed that very few papers had been written by authors from South and Southeast Asia (excluding India). These data suggested a need for capacity building in DHS data use and analysis in this region.The current model of the program is a result of the major modifications discussed above and many other improvements over the years. The current model has more streamlined processes for participant selection, 2 in-person training workshops, and postworkshop activities.The current model of the program is a result of previous modifications, including improvements to participant selection, training workshops, and postworkshop activities.In October or November of every year, DHS issues a call for applications from universities in the targeted countries. These countries are selected based on the availability of recent DHS data and the existence of universities offering academic programs in population and health. Countries targeted can vary every year; priority is given to those that have never participated or have had low participation in previous program rounds. Other important considerations relate to the amount and type of funding available for the program. The program typically selects 5 or 6 teams, each composed of 3 faculty members, on a competitive basis using criteria such as quality of the research proposal, applicants' experience and baseline skills in data analysis, suitability of the proposed capacity-building activities to the applicants' university, country diversity, and gender balance. As the competitive selection process may result in applicants from resourceful universities having a better chance to be selected, the program carefully assesses the diversity of selected universities to reduce repeating participation from the same universities.The program provides in-person training through 2 workshops led by DHS technical staff. These 2-week workshops are usually held in the fellows' home countries so that it is possible to involve DHS implementing agencies and other stakeholders, including the USAID Mission. Fellows also receive intensive remote guidance and feedback before and after workshops.Before the first workshop, an online preworkshop assignment prepares the fellows for the training. This includes downloading the required DHS datasets and completing a short course on the objectives and coverage of the DHS Program. The online platform also includes other important learning resources and allows fellows to interact with DHS facilitators. The training curriculum for the first workshop prepares fellows to analyze DHS data from their respective countries. Topics include DHS questionnaires, DHS recode data files and variables, principles of survey sampling and weighting, how to account for complex survey design in the analysis, use of statistical software  for analysis, dataset merging, variable recoding, and multivariate regression analysis. For each topic, the concepts are presented and then enhanced by participatory exercises in Stata. The curriculum also includes discussions on research conceptualization, preparation of a tabulation plan, scientific writing, research ethics, and citation software. During this workshop, fellows' teams also work with DHS facilitators to refine the design of their research projects and to conduct preliminary data analysis. Research topics are related to reproductive health, family planning, maternal and child health, HIV, nutrition, and gender issues. Pre- and posttests are used to evaluate the effectiveness of the training.Between the first and second workshops, while back at their home university, fellows prepare and submit a draft working paper, for which they receive extensive reviews and comments from the DHS staff. The second workshop, which takes place approximately 2 months after the first workshop, concentrates on revising and finalizing the working paper draft, to ensure that the research meets publishable quality standards. By the end of the second workshop, most teams are nearly finished with their revised paper. During this workshop, fellows are also introduced to more advanced topics such as estimation of fertility and child mortality using DHS data and analyzing DHS calendar data, as well as more advanced statistical methods such as multilevel modeling, survival analysis, and decomposition analysis. These topics are selected based on fellows' interests and skills. All the training materials are shared with the fellows for their own teaching and capacity-building activities. DHS is also currently putting these training materials in an online repository to benefit more DHS data users. For each workshop, a final evaluation is conducted to solicit feedback on training quality and usefulness.In addition to completing a research paper, fellows are required to design and implement a series of capacity-building activities at their home universities to share their learning with students and faculty colleagues. Activities typically include integrating DHS data into their teaching curriculum, department seminars, and research meetings to increase awareness of DHS data; mentoring graduate students to use DHS data in theses or dissertations; and conducting DHS data analysis workshops for students and faculty. Fellows conduct these activities primarily with support from their home university. The teams are required to submit 2 reports on the implementation and results of these capacity-building activities.Supplement) such as Studies in Family Planning, PLoS One, BMC Pregnancy and Childbirth, African Population Studies, Reproductive Health, and the International Journal of Population Research.Since 2011, the Fellows Program has trained 152 researchers from 45 universities in 25 countries in Africa, Asia, and the Middle East . The proSince 2011, the Fellows Program has trained 152 researchers from 45 universities in 25 countries in Africa, Asia, and the Middle East.Beyond their fellowship papers, fellows have continued to use DHS data in their own research, and many have published other research based on DHS data after they participated in the program. In 2016 and 2017 alone, 15 papers were published by former fellows. Many fellows have presented their research findings based on DHS data at national and international scientific meetings. These post-fellowship activities have been self-motivated and have not received financial support from the DHS Program.In addition to producing sound research based on DHS data, the Fellows Program has substantially increased institutional capacity to analyze DHS data through the fellows' capacity-building activities at their home universities. Many activities continue after the end of the fellowship. Fellows are particularly successful when there are other fellows from previous cohorts working at the same university. For example, teams of Nigerian fellows from Obafemi Awolowo University who participated in different rounds of the Fellows Program  have worked together and conducted annual training on DHS data analysis since 2012. In 2014, they expanded the training beyond students and faculty in their university to other universities and nonacademic research institutions. Between 2012 and 2016, they trained over 100 participants from a variety of universities and organizations in Nigeria to use DHS data. Fellows from several cohorts at Makerere University in Uganda also collaborated to expand capacity-building activities and conduct research based on DHS data. By involving participants from government agencies and local organizations, some fellows have built a network with local stakeholders for future collaboration and data analysis support to these organizations.blogs on the impact of the Fellows Program on themselves and their university. We present 2 quotes below from the fellows.Fellows have written Since 2018, I published 2 journal articles and presented 2 oral presentations at the 10th and 11th International Conference on Public Health among Greater Mekong Sub-Regional Countries. In addition, 3 of my MPH students prepared their proposals using DHS data this year. Myanmar is now realizing the data quality and accuracy of DHS indicators, so, not only academicians and students but also program managers and policymakers are using DHS indicators in relevant situations. —Fellow from Myanmar 1 year after completing the 2018 programThanks to the Fellows Program, we are better equipped to use this data in other work and have shared it with our colleagues during our capacity-building activities. Some colleagues are already hoping to participate in future Fellows Program or other DHS workshops. This program not only allowed us to better understand the DHS surveys, but also make in-depth statistical analyses and to use DHS data to write analysis reports. —Senegal team in the 2019 programThe Fellows Program has shown continued impact on fellows and their institutions after the fellowship ends. We analyzed data from a follow-up survey conducted 6 months after the conclusion of the program with the 2015, 2016, 2017, and 2018 cohorts. The response rate was 100% from all cohorts except the 2018 cohort, for which it was 83%. The Fellows Program has shown continued impact on fellows and their institutions after the fellowship ends.The Fellows Program has also been an important source of south-to-south consultants for other analysis workshops of the DHS Program. Alumni fellows have a combination of technical skills gained through the program and considerable experience with teaching—their main occupation. Former fellows have often been invited back as co-facilitators in many types of DHS workshops, including subsequent fellows workshops. By 2019, 20 fellows had been invited back to co-facilitate fellows workshops and other DHS data use and analysis workshops, as well as to co-author reports that further analyze their country's DHS data. Former fellows had very positive feedback on the value of facilitation for their careers and further improvement of their analytical and research skills.While achieving many successes, the DHS Fellows Program also faces challenges related to fellows' diverse backgrounds, experience, and skills; logistical difficulties in organizing in-person workshops; language barriers; and fellows' varying levels of commitment.While achieving many successes, the DHS Fellows Program also faces challenges.Teams are selected through an open competitive process that involves rigorous assessments of skills and experience based on applications. However, the baseline capacity of the participants can still vary greatly, particularly in prior knowledge and use of survey data, computer skills, familiarity with statistical software, and research ability. Most fellows have been junior faculty with a master's degree received from their home country and very limited previous experience working with large survey datasets and complex analytical methods. In addition to various skill levels, fellows come from a wide range of research backgrounds, including demography, public health, medicine, social sciences, psychology, and health systems. While this diversity has its advantages in expanding the fellows' exposure to various research areas, it also creates challenges for teaching and mentoring the fellows. The DHS facilitators must engage different interests and accommodate varying skill levels during lectures and hands-on work, while still ensuring that all content is covered within a fixed amount of time. Facilitators must provide one-on-one intensive mentorship to teams with limited skills. At times, major adjustments to fellows' research proposals are required to narrow their original scope or to shift to simpler analytical methods if the team has limited capacity. Teams with more experience are encouraged to apply more advanced methods in their research. Cofacilitators, typically former fellows, provide extra assistance during the limited time available. They also liaise between the DHS facilitators and fellows and are especially helpful in bridging differences in culture and primary language.Despite the efforts to encourage women's participation in the Fellows Program, for example, making gender balance an explicit selection consideration, the proportion of female fellows is low, constituting less than 40% in 7 rounds between 2011 and 2020. This proportion is consistent with the sex ratio among all applicants, reflecting the underrepresentation of women in academia in low- and middle-income countries.The in-person workshops for fellows are usually held in the home countries of the participating teams, but the selection of the workshop locations must consider accessibility in terms of flights and visas for all the teams. Since the program was expanded to include scholars from both Asia and Africa, the program has aimed to have 1 workshop in Asia and 1 in Africa. Due to the wider geographic dispersion of DHS countries in Asia, it is more difficult to identify an optimal location in Asia than in Africa. There are fewer options for a location with reasonable flight times and no overnight stays during travel. At times, visa accessibility becomes a very critical factor in choosing where to have the workshops, especially when the program includes countries with limited visa access to other countries. Sometimes fellows must travel to a neighboring country because the country for which they need a visa does not have an embassy in their own country. Countries that do not require a visa or that allow for an e-visa are advantageous for workshops, although the travel cost is sometimes higher or the itineraries not as convenient. Therefore, the choice of location is determined by a balance of several factors. For example, 1 workshop was held in Thailand, a non-DHS country, because it offered better visa access, was less expensive, and had more convenient flights than any of the fellows' host countries. This selection, however, did not reflect the goal of having workshops in countries with DHS surveys to better engage local stakeholders.To date, English has been the primary language for the Fellows Program, even though it is not necessarily the primary language in the fellows' countries. For example, although English may be one of the official languages in East African countries, Swahili is more widely spoken than English. The use of English as the program's medium can be a language barrier for some fellows. Recognizing this, DHS uses several measures to overcome language barriers. These include, but are not limited to, making the teaching materials clear, simple, and concise; always sharing presentations and statistical software programs with fellows; providing exercises for fellows to practice on their own time; and encouraging fellows to ask questions during presentations. The training curriculum has been translated into other languages such as French and Arabic and shared with fellows. The program enlists co-facilitators who play an important role in helping the fellows with language challenges. Co-facilitators are former fellows who have an especially good understanding of the training materials. They have been very helpful in offering supplementary explanations, often in their own language. Fellows are generally active in discussions and ask questions during presentations. Given the preparation and assistance, language has not been a major problem in effectively communicating and has not been a barrier to understanding training materials.Writing a scientific paper in English is challenging for almost all fellows—as it is for any non–English-speaking researcher. There is no easy way to overcome this hurdle despite the sharing of materials on writing a scientific paper that include a working paper template. All fellows' papers are professionally edited, and fellows review the edits before publication.Fellows' commitment to the requirements and aims of the program is critical to its success. Such commitment includes being responsive to travel arrangements, full participation in the 2 workshops, and timely submission of deliverables. To ensure fellows' participation, especially their travel to the workshops, fellows are required to submit a letter of approval from their universities, assuring permission to participate. DHS also issues a contract with each fellow at the beginning of the fellowship with detailed specifications of activities, deliverables, and timelines, as well as penalties for noncompliance. On a few occasions in both regions, some fellows have been unable to attend the second workshop due to unexpected work commitments. These fellows are usually the senior members of teams. Senior members are helpful in overseeing teamwork and ensuring capacity-building activities at the home university, but they face special challenges in committing the time required to complete the program. They may work remotely with other team members to complete the work, but their absence from workshops has a negative effect on productivity and morale. Thus, DHS is now more cautious about enrolling fellows with high-level administrative positions.With support from USAID, the DHS Program plans to continue the current model of the Fellows Program with further improvements where possible. The program will continue to include a mix of scholars from Asia and Africa, a feature that has received very positive feedback from participants since it increases collaboration between the universities and fellows in the 2 regions. The program is considering expansions in several areas.The DHS Program plans to continue the current model of the Fellows Program with further improvements where possible.We hope to expand the program to more countries and universities, especially, more francophone countries. The use of English has limited our ability to include francophone countries in the past, but it has not prevented it entirely. Our experience with including teams from Burkina Faso and Senegal was successful because the teams had a strong background in public health or demography, had prior experience using DHS data, and had some, albeit limited, English skills. To facilitate their participation, DHS included bilingual facilitators during the workshops and provided all materials in French as well as English. In the 2020 round, more French-speaking countries were targeted in the call for applications and 3 French-speaking teams  were accepted. The inclusion of non–English-speaking teams is an important expansion of the Fellows Program but does imply a need for increased funding to accommodate these changes.Expanding the program to include research institutions was another option that was explored, especially for countries that do not have universities with strong programs and faculty in relevant disciplines. In 2019, the DHS Program experimented with this option but received very few applications, none of which survived the review process. One concern about including research institutions is their limited potential for skill cascading because they do not usually teach students. Skill transfer is certainly possible among research colleagues in the same institution, but higher job turnover compared with universities may reduce the impact. If research institutions are included in future programs, they need to be carefully selected to take into account their potential for capacity-building activities, and their incentives and motivation for continued use of DHS data.Almost all training materials have been delivered to fellows through the in-person workshops. Given technological advances, it is now possible to deliver some of the materials through online courses before workshops to reduce the duration of the in-person training. The current program requires fellows to complete an online prework assignment that provides basic preparation for the in-person training. The current prework could be expanded to include some sessions that are usually provided at the beginning of the workshop, such as introductory sessions on Stata, understanding DHS standard recode files, using the DHS recode manual, and finding variables in DHS data files. Virtual learning has its constraints including limited inter-team interactions and requirements for reliable internet connectivity, which is not always possible in many fellows' countries. The second workshop of the 2020 Fellows Program was held online because of the COVID-19 pandemic. While it was found during this workshop that the virtual format was not effective in discussing complex technical topics, such change did not prevent the program from achieving its primary goal. Fellows increased their knowledge of DHS, mastered critical skills for analyzing DHS data, and successfully completed their research projects. Overall, training through a virtual platform can be a useful and economic supplement to in-person training if designed carefully.Overall, the DHS Faculty Fellows Program has evolved to create and strengthen capacity in low- and middle-income countries in the often neglected but critical areas of data analysis and research. The program has been successful in supporting high-quality research during each round and stimulating subsequent trajectories of research productivity as evidenced by many peer-reviewed publications by former fellows. The inclusion of several countries in each round has promoted a better awareness of research issues and opportunities in different countries. The program has had a cascading effect by targeting university faculty and requiring them to develop mechanisms such as workshops and course modules within their home universities. The program has also strengthened the links that university faculty have with government agencies and USAID Missions, providing in-country expertise for the analysis of programs and policies. The experience and lessons learned in implementing the DHS Faculty Fellows Program provide a blueprint for other programs aiming to build capacity in analysis and use of data in low- and middle-income countries.


As a result of destruction and lack of access to vital infrastructures and mental stress, disasters intensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aim of this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatment and management of CVDs at the time of natural disasters. In the present systematic review, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado.The search led to accessing 4426 non-duplicate records. Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively. Prevalence of CVD increases after disasters. Lack of access to medication or lack of medication adjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication, self-management, and self-care incentives along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension.  Over recent years, the number of disasters and their costs has been increasing and is 6 times higher compared with the first half of the last century -3. For iCardiovascular diseases (CVDs) is the main category of NCDs whose incidence and prevalence have an increasing trend due to changing life style and aging population -10. NCDsThis is a systematic review based on PRISMA protocol. In this study, PICO is defined as: P, which stands for problem or population, is individuals with cardiovascular diseases, (I) is natural disasters, (C) comparing normal situation, and the (O) outcome is prevalence, treatment, and management of CVDs. Eligibility CriteriaIn the present study, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criterion was study of CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), arrhythmia such as atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), and paroxysmal supraventricular tachycardia (PSVT), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado. The articles published in the form of abstract as a poster, conference proceeding, commentary, editorial, and case report were excluded. In this study, volcano and climate changes were not included. Similarly, man-made disasters were excluded and not reviewed. Search StrategyIn order to achieve the purpose of the present study, search items and their related key terms were selected by means of using MeSH and EMtree databases, consulting with expert specialists, searching the titles and abstracts of the related articles under supervision of a specialist and researcher in emergency medicine and a health management in disasters Ph.D. An extensive search in electronic databases including Medline, Web of Science, Embase, and Scopus until 28. 11. 2020 was done. Search strategy in Medline database is presented in Study Selection and Data Collection Process and Outcome Appraisal  In this study, all articles published in English language, which studied CVDs in natural disasters, were included. Screening of the articles was done based on inclusion and exclusion criteria. First, abstracts of the articles were read by two independent researchers. Then, after selecting the eligible articles, full texts of the articles were evaluated. Afterwards, the full text was considered in accordance with inclusion and exclusion criteria and eligible articles were selected. Summarizing the articles and recording the data in the checklist along with final quality control was performed by two independent individuals. Any discrepancy in views was resolved through discussion between two parties or by means of consulting a third researcher. The articles were summarized using a checklist, which has been designed based on PRISMA statement . In thisStatistical analysisData analyses were done in a descriptive way. All the articles were summarized and categorized based on the considered variables. EthicsSince systematic review studies consider the previously published studies and the research is not directly done on human or animal, there is no need for ethical approval. Study Selection andStudy CharacteristicsThe search led to 4426 non-duplicate records. 4,199 abstracts were excluded as they were not related to the purpose of our study. Also, 115 studies were case report, letter to editor or Correspondence, review articles, abstracts presented at the conferences and non-English, all of which were excluded from the study. 112 article abstracts were eligible and hence necessary measures to provide their full text were taken. Also, six full text articles were studied but since they did not meet our criteria, they were excluded. We were not able to the find full text of two articles. They were not even accessible in the journal archive. Finally, the data of 104 articles were included in quality control appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively. The selection process and PRISMA diagram are shown in Quality control of study and risk of BiasThe included articles were qualitatively considered. The qualitative review results of flood, storm , and earthquake are presented in CVDs in Flooded Areasth week  Prevalence of CVDs including HTN, AMI, and fatality caused by CVDs increase after hurricane -24. In tAt the time of evacuation, some patients forget to take their medication out of their home and some of them run out of medication or cannot obtain them and lack of medication makes them unable to control their HTN and hence uncontrolled HTN increases , 30. TheTo improve the quality of health care services, the following points are recommended : 1. HaviEarthquakeSo far, numerous earthquakes have occurred. Out of these earthquakes, the Great East Japan earthquake in 2011 with the magnitude of 9 on Richter scale was one of the most severe ones, which caused triple disasters . In addiBased on the studies performed after the earthquake, prevalence of CVDs such as HTN, ACS, AMI, IHD, HF, VF, sustained or non-sustained VT, and cardiomyopathy and other types of mortality increase after the earthquake -79. The th and 20th of 1978 with the magnitude of 5.2 and 6.4 on the Richter scale, respectively  increases in the people with chronic diseases such as renal failure , 95. OthThe time, at which the earthquake takes place, is another factor affecting the incidence rate of CVDs. For instance, Loma Prieta earthquake, in 1989, took place at 5:04 pm in San Francisco. The magnitude of the earthquake was 7 on the Richter scale. In comparison with the days before or after the earthquake or in comparison with the same day in 1990, on the day of Loma Prieta earthquake, there was not any statistically remarkable increase observed in AMI admission in San Francisco area. Northridge, Los Angeles, earthquake in 1994 occurred at 4:31 am and there was a 110% increase in the rate of AMI admission in Los Angeles on the day of the earthquake in comparison with the mean admission rate over 7 years before the earthquake. Sudden death rate also increased. Therefore, severe emotional stress resulting from sudden wake-up stress affects the increase in AMI. And if there is less stress, AMI risk is lower as well , 97. In fact, stress plays a pivotal role in increase in incidence of CVDs, which mostly happens because of mental stresses such as losing property and relatives , 85, 98.One of the other reasons for uncontrolled Blood Pressure is discontinuity of antihypertensive drugs, which happens because of various reasons. In the people with psychological problems, the risk of stopping using antihypertensive drugs is higher . One of the cases with different results is a study carried out in New Zealand. In this study, after two earthquakes, there was no increase observed in ventricular arrhythmia . AnotherFukushima Area after the Great East Japan Earthquake Areas within 20 km of Fukushima nuclear power plant were determined as high-risk and restricted areas due to nuclear radiations more than 20 mSv per year. Almost all of the residents had to evacuate their homes , 107. FrIncidence of HTN, tachycardia, MI, AF, and the deaths related to CVDs was higher in the individuals who had to abandon their homes -113. CVDStress is a leading factor in increasing the risk of CVDs and hence, a higher rate of CVD is observed in individuals with depression and PTSD  and therIn comparison between evacuees and non-evacuees, there was no difference or little difference in term of increase in BP . Special Groupsrd trimester of pregnancy at the time of incident and stress more commonly had pregnancy HTN  after a main EQ . PrescriAfter crises, it is more likely that patients stop taking drugs, encouraging hypertensive patients to start taking drugs again may help reduce CVD risk . After the earthquake, changing the patients’ antihypertensive drugs is another important measure that leads to better control of HTN. Data show that after earthquake, paying special attention to BP level and treatment modifications can be important not only immediately, but also for some months after the earthquake . StudiesSupplying a morning home blood pressure measuring device to control morning home blood pressure is essential for preventing CVDs’ side effects . Due to Timely and appropriate intervention is another factor that can help reduce due to CVDs. Complications like HF can occur less under the condition that patients are immediately admitted for AMI and the treatment begins quickly . Also imIn this systematic review study, incidence and prevalence of CVDs, morbidity and mortality of CVDs, and treatment and management of CVDs, were investigated. Prevalence of CVDs increases after disasters. This increase directly depends on the intensity of the damage to the disaster area. The most import reason for such an increase are stresses like losing home and relatives and friends, disconnection with friends and relatives, losing job and joblessness, and lack of consistency following the incident. Also, high-risk individuals like the elderly are more susceptible. However, using appropriate medication and non-medication measures in terms of stress, it is possible to decrease prevalence of CVDs. Quick establishment of health clinic and access to appropriate and quick treatment within a few months after disaster is of other measures that can help control CVDs. Such measures like providing and providing access to medication, consulting to change dose or type of medication, and encouraging self-management and self-care can help decrease these complications to minimum. Similarly, it is essential to pay attention to special populations like pregnant women, particularly within their third trimester of pregnancy and children under 15.In a review study, Kazuomi Kario et al., 2012, studied the effects of 2011 Great East Japan earthquake and Hanshin-Awaji earthquake on CVDs. This study probed into in-clinic and off-clinic HTN, potential mechanism of HTN in disasters, and management of these diseases. The results indicated that BP increases after earthquake and complications related to lifestyle, like stressful factors such as bad quality of sleep, and complications related to activity, such as lack of physical movement after earthquake, can lead to biological rhythm disorders. Aldosterone and cortisone increase in biological rhythm disorders and consequently sympathetic nerve is stimulated, which leads to increase in the use of salt and hence HTN. In this study, controlling use of salt along with establishing a quiet sleeping condition, being away from stress, appropriate physical activity, and having self-management to prevent obesity are mentioned as important factors to control HTN . Similarly, in our study, controlling stress, encouraging self-care and self-management, and providing BP measuring device to facilitate self-care and self-management are taken to be important factors to control HTN. But, in the study done by Kazumi, providing BP measuring device to facilitate self-care is not mentioned . In 2015In this study, non-English articles were excluded, which resulted in losing some data. Prevalence of CVDs increases after disasters. Lack of access to medication or lack of medication adjustment, losing home BP monitor device as a result of destruction, and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinic, providing quick access to appropriate diagnosis and treatment, providing access to medication, and self-management and self-care incentives, along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension. There is no conflict of interest


Background: Finding the ideal candidate for a residency/fellowship program has always been difficult. Finding the “perfect” match has always been the ultimate goal. However, many factors affect obtaining that “perfect” match. In the past, we would have each attending physician review around 20 to 50 Electronic Residency Application Service (ERAS) applications and rank them into three categories: high, middle, or low. Depending on their ranking, the applicant would be invited for an interview. After the interview, the applicants’ files (ERAS and interview) would be reviewed and ranked by the faculty as a group. This was time-consuming and fraught with too much subjectivity and minimal objectivity. We, therefore, sought to find a way to assess and rank applicants in a more objective and less time-consuming manner. By creating a customizable scoring tool, we were able to screen applicants to our pulmonary/critical care fellowship program in an efficient and a more objective manner.Objectives: A customizable scoring tool was developed weighting components in the ERAS and interview process, allowing residency/fellowship programs to create a final rank list consistent with the programs’ desired applicants.Methods: Two hundred and sixty pulmonary/critical care fellowship applications were reviewed from 2013 to 2018. In 2018, we used our new scoring rubric to create a rank list and rescore previous applicants. The traditional and new lists were compared to the final rank list submitted to the National Residency Matching Program (NRMP) for 2018. We wanted to ascertain which scoring method correlated best with the final rank list submitted to the NRMP. We obtained feedback from eight faculty members who had reviewed applicants with both scoring tools.Results: The novel customizable scoring tool positively correlated with the final rank list submitted to the NRMP (r= 0.86). The novel tool showed a better correlation to the final rank list than the traditional method. Faculties  responded positively to the new tool.Conclusions: Our new customizable tool has allowed us to create a final rank list that is efficient and more focused on our faculty’s desired applicants. We hope to assess and compare the quality of applicants matched through this scoring system and the traditional method by using faculty evaluations, milestones, and test scores. In 2019, it was noted that pulmonary/critical care medicine was the second most popular fellowship choice among the internal medicine specialties [Applicants are initially reviewed through the Electronic Residency Application Service (ERAS) which was created by the Association of American Medical Colleges in 1995. The ERAS system contains a wealth of information about each applicant, including medical school, class rank, grades, residency programs, research experience, personal statement, and letters of recommendation. Our pulmonary/critical care program accepts four pulmonary/critical care fellows per year, and we receive and review approximately 300 applications each year. With the increasing dearth of critical care physicians, there has also been an increase in the number of pulmonary/critical care fellowship programs and positions available in the United States. Reviewing each individual applicant in sufficient detail is a formidable challenge for busy clinical faculty members.We have sought a way to evaluate prospective applicants that would be less time-consuming, yet more aligned with what our fellowship program desires in an applicant. We have focused solely on objective measures when selecting candidates, as many additional factors are at play including the contents of personal statements which shed light on applicants’ reasons for pursuing a particular field and the life experiences they have had to date. However, as important as it may be, the personal statement cannot stand alone when selecting an applicant; other variables must also be evaluated. Many programs have attempted to develop a screening process to find the ideal applicant for their programs. Screening processes have included an assessment of the undergraduate and medical schools from which the applicant graduated, class rank, GPA, research experience, letters of recommendation, personal statements, and interviews. Unfortunately, there has been no consistently validated means of screening applicants -10. The We aimed to create a similar customizable ranking tool when selecting applicants into our pulmonary/critical care fellowship program in the hopes of making the process more expeditious and finding fellowship candidates who would be an ideal fit for our program. By focusing on specific characteristics that we felt were more important than others, we hoped to capture the particular candidate who we felt would be successful in our field and in our program.A new scoring rubric was developed whereby individual characteristics found on an applicant’s ERAS application could be weighed and prioritized depending on the preferences of the program. The scoring tool included scoring various attributes that are included in the ERAS application  regulatory categories 2 and 4.The newly developed customizable scoring tool used in 2018 had a good correlation with the final rank list that was submitted to the NRMP  to see how applicants would deal with certain situations . Trying With the COVID-19 pandemic and the importance of social distancing, new ways of interviewing applicants will need to be explored. The Accreditation Council for Graduate Medical Education (ACGME) is currently exploring virtual interviews as a safe way to meet applicants. As our scoring tool places 60% weight on the interview of an applicant, the weight of the interview may need to be adjusted once we are able to assess how the virtual interviews are able to capture the true essence of an applicant. As virtual interviews save costs not only for the programs but also for the applicants, these interviews or at least a hybrid of virtual/in-person interviews may become the standard for the future. Nevertheless, prior to matching the applicants, this could be problematic for both sides as the program would not physically meet the applicant until they start the residency/fellowship. Additionally, the applicant would not get to tour or meet the current residents/fellows in their future program, thus not allowing both sides the opportunity to better assess if they would be a good fit. Only time will allow us to see if virtual interviews are as efficacious as real-life interviews.We plan to assess the quality of the applicants who we have matched through the traditional method and the new customizable scoring tool by comparing their evaluations from faculty members, test scores, and milestones. As our desire for certain qualities in our applicants evolves, we can adjust the percentages and even elements in the rubric thus customizing the rubric to what we desire in our fellows. We plan to evaluate the fellow’s milestones and review internal surveys to see if our program was an ideal match for the fellow and the fellow an ideal match for the programInterestingly, there is an online company created by a pediatrics/anesthesiology resident and an anesthesiology program director who is also currently an associate designated institutional official (DOI) who formed a company named Thalamus. This company creates an online platform that helps both the program and the trainee with the application and interview process. They state on their website that they can assist the program with scoring and ranking applicants by creating scoring algorithms by measuring a candidates’ fit with a program.Ranking applicants to fellowship programs remain both challenging and time-consuming. Additionally, different programs vary in the indicators they choose to rely on and how those indicators are weighted. In this study, we developed a customizable scoring tool to rank applicants to our fellowship program by creating a composite score for each applicant. This tool weighted and utilized components in ERAS and the interview process in order to create a final rank list that remained consistent with the desired applicants for our residency/fellowship program.Our results confirmed that this new customizable scoring tool has allowed us to create a final rank list that is helpful in narrowing the applicant list to our faculty’s desired applicants. In regard to the new scoring tool, a faculty member said, “There is a slight improvement, still hard to judge the applicants based on a single interview.” In other words, although designing scoring tools is vital and improves the application process, further research should focus on expanding ways of judging applicants apart from interviews or on improving the interview process. Although this study is a small/pilot study, we feel that the rubric has potential in selecting applicants applying into a residency/fellowship program. Only with time and likely with many modifications to the rubric, will we know how useful this tool can be. There are multiple parts of the application process that can be improved upon and this is just a start. We hope to share this customizable scoring rubric with other programs to create a more efficient and effective way to manage the residency/fellowship application process.