Iranian Journal of

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Background & Objectives: Chronic pain is one of main public and individual health problems and its epidemiological understanding needs reliable estimates of prevalence. The aim of this study was to investigate the epidemiology of chronic pain in all 368 neighborhoods of Tehran using small area estimation method.
Methods: The pain section from the second round of Urban HEART data from a selected individual of 23457 households in Tehran using a multistage randomized cluster sampling in 2011, were analyzed. In order to obtain reliable estimates for chronic pain prevalence at neighborhood level, a generalized linear mixed model and hierarchical Bayesian approach were used and the reliability of the estimates were evaluated.
Results: The average of estimated prevalence of chronic pain in neighborhoods of Tehran was 25.5% and a large heterogeneity was observed in its prevalence in neighborhoods of Tehran. Prevalence of chronic pain was significantly higher in married housewives, retirees and pensioners and was significantly associated with age, educational status, depression and anxiety (P<0.05). The reliability of Bayesian method was confirmed by evaluation methods in this analysis.
Conclusion: These results demonstrate prevailing amount of chronic pain at neighborhood-level in Tehran, which warrants careful attention to prevention, treatment, and rehabilitation by health care professionals.

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Background & Objectives: Although several studies have been carried out for evaluation of the first birth interval, none of them has considered the presence of infertile women within the sample. Therefore, the aim of this study was to employ survival analysis to study the first birth interval and its determinant factors more accurately.
Methods: In Data from 1068 married women of reproductive age in west Azarbaijan province were considered in this investigation. Two-stage sampling design was used to collect data via a questionnaire, modified Gompertz model, a special kind of cure models, was employed in this study. For descriptive and analytical data analysis, SPSS 16 and R 2.12 were used respectively.
Results: In this study, the average interval between marriage and first birth was 3.9± 0.7 (± SD) years. Using modified Gompertz model, among all demographic factors only mother’s education had significant effect on the first birth interval so that with increasing mother’s educational level, the first birth interval had also increased. (P =0.007). In addition, the estimation of the proportion of women who did not have any children was 0.062 that showed a positive trend with increasing mother’s educational level.
Conclusion: This study revealed that due to the presence of infertility among married women the use of Modified Cured Gompertz model is an appropriate method for evaluation of the first birth intervals and it's determinant factors.

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Background and Objectives: Inequity in health is a universal term which used for showing current differences, variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers.
Methods: The calculation, advantage and disadvantage of most common health-inequity indexes including slope index of inequity, relative index of inequality, Theil’s Index, mean log deviation, index of disparity, Gini coefficient, weighted utilization social welfare function, absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data.
Results: Average of health care utilization in in-need subjects was 66.4%. This indicator was in the first to fifth quintiles equal to 57.6%, 63.4%, 71.6%, 69.5% and 75.3%, respectively. Relative concentration index and Gini coefficient was calculated as 0.053 and 0.0062, respectively.
Conclusion: Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes, concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

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Background & Objectives: Randomized controlled trials are the most reliable type of study to be able to compare different interventions in scientific research. The introduction of bias into the design and conduct of randomized controlled trials can seriously affect the accuracy of the results and led to the results be invalid. The aim of this study was to assess the bias in randomized controlled trials published in Iranian nursing and midwifery journals.
 Methods: We searched all published articles in eight professional nursing and midwifery Iranian journals in 2010. Risk of bias in RCTs was assessed using of Cochrane group risk of bias standard tool by two reviewers independently.
Results: After reviewing the eight journals, 68 randomized controlled trials were retrieved. The majority of studies had unclear or high risk of bias. Random sequence generation in 22%, concealment allocation in 4.5%, blinding in 22%, incomplete outcome data in the 35.3%, selective outcome reporting in 51.5%, and other bias in 36.7% of the studies were in low risk of bias.
 Conclusion: A large proportion of the studies had high or unclear risk of bias. It was considerable that none reporting bias led to uncertainty reader from study quality. Bias might significantly affect the internal validity of the studies results therefore in interpretation of the findings of these studies caution should be taken.

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  Background & Objectives : Migraine is the most common type of headache in children. Over 30% of patients have disabilities, so early detection and timely treatment is necessary to prevent attacks, increase learning, and prevent absenteeism. The aim of the study was to determine the prevalence of migraine in children.

  Methods: In this cross - sectional study with two-stage stratified random cluster sampling the International Headache Society (IHS) for migraine diagnosis and (PedMIDAS) questionnaire were completed through interviews with the students’ parents. Data was analyzed with SPSS software and chi-square test.

  Results : Of 1117 children with a mean age of 41.1 ± 9 years, 551 (49.3) were female and 556 (50.7) were male of whom 185 (56.16%) had a headache and 40 (2.16%) had migraine. Most of the time, the pain started on the first day of the week with a moderate intensity. Aggravating factors were physical activity and stress, and alleviating factors were sleeping and resting. The pain was bilateral and was accompanied by nausea and vomiting. The mean number of headache attacks in the past three months was 8.85± 7.65 which lasted for a mean duration of 6.38 ± 8.02 hours with a mean interval of 24.70± 26.21days.

  The frequency of migraine in children by age and sex were not significantly different. More than of the children had a positive family history but were not visited by the doctor. About 79.37% of the students had first degree disability, %54.10 had second degree disability, %9.05 had third degree disability, and % 1.04 had fourth degree disability.

  Conclusion: Given the increasing prevalence of migraine with age and the risk of chronic diseases and individual and social impairment, it is important to prevent headache attacks through early identification and moderation of the aggravating factors and education of non-medical preventive methods.

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  Background & Objectives : Leadership power and management are discussed as sensitive and key elements in the safety issue. A safety leader can provide the necessary incentives for hard work, efficiency, and more productivity in the organization which includes various working groups and also strengthening a sense of individual responsibility to promote the safety performance in order to achieve the organizational goals. This study aimed to determine the validity and reliability of the Safety Leadership Questionnaire in the vehicle manufacturing industry.

  Methods : This cross-sectional study was conducted on 260 employees of Pars-Khodro Company in the manufacturing lines. All samples were selected randomly. The validity of the questionnaire was determined by statistical methods such as exploratory factor analysis, confirmatory factor analysis, and the heterogeneity between questions. Also, the Cronbach's alpha was used in order to investigate the reliability of the questionnaire.

  Results: The results of exploratory factor analysis showed three factors including decision making, control, and incentives explained 66 percent of the total variance. Confirmatory factor analysis represented the appropriate fitness of information with a three-component structure (P<0.001, df = 2, 𝜒 2 = 5.36, CFI = 0.957, RMSEA = 0.089). The Cronbach's alpha coefficient was higher than 0.7 for all three factors.

  Conclusion : In this research, decision making was an important factor in measuring safety leadership. Moreover, the present study represented an indicator which could be used in the other surveys of safety and industrial psychology.

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Background and Objectives: Brucellosis is a zoonosis disease that is important in humans and animals. Since the disease is important in ranchers and veterinarians, we conducted this study to estimate the seroprevalence of the infection in these groups in Kerman.

Methods: In this descriptive and analytical cross-sectional study, 187 industrial and semi-industrial dairy personnel and veterinary network staff of Kerman in 2012 were recruited. Rose Bengal, Wright and 2-Mercaptoethanol were done on serum samples. Demographic and occupational characteristics of the participants were recorded. Data was analyzed using descriptive statistics and Poisson regression via the Stata software. Results: The prevalence of brucellosis was 3.2%. In this study, the history of brucellosis in the family, working in the veterinary network, and working in semi-industrial versus industrial dairy farms were the risk factors of the disease.

Conclusion: Although the prevalence of the infection was lower than other studies, it was still considerable in these groups therefore, it is necessary to improve preventive measures in these groups.

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Background & Objectives: Urinary calculi are a common problem worldwide. The pattern of fluid consumption in healthy people and patients with renal calculi is not totally clear. The aim of this study was to determine the association between the amount of fluids intake and urinary calculi.

Methods: In this case-control study, cases were the patients with urinary calculi admitted to Emam-Hossein Hospital, Shahroud, Iran. The controls were selected among the patients admitted to other wards of the hospital except for dialysis and ICU wards. The association between independent variables and urinary calculi was investigated using logistic regression analysis.

Results: A total of 127 people (60 cases and 67 controls) participated in this study. The mean age of the participants was 44.6 years (SD = 1.7). The mean intake of tea, natural juice, alcohol free beer, and total fluid intake were higher in cases compare to controls. In participants with a negative history of urinary calculi, the total intake of fluid (P=0.021) and natural juice (P=0.006) was higher in cases. The male gender (OR=3.2), higher BMI (OR=1.2), and a positive family history of urinary calculi (OR=3.5) were associated with renal calculi in a multivariate logistic regression model, while the milk intake (OR=0.995) was a protective factor in this model.

Conclusion: Milk intake is a protective factor and the male gender, higher BMI and a positive family history are the risk factors for urinary calculi.

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Background and Objectives: By identifying the causes of death, interventions can be designed and implemented to reduce the risk factors of different diseases. The aim of this study is to determine the trend of ten leading causes of death in the Islamic Republic of Iran in 2011.

Methods: The study population comprised all deaths recorded in the death registration system of the Ministry of Health and Medical Education (MOHME) from 2006 to 2011. The data related to causes of death reviewed and modified in terms of quality, underreporting of deaths, and garbage codes using the Global Burden of Disease study methods. Finally, the data were analyzed by sex and age groups.

Results: The leading causes of death were cardiovascular diseases (46.12%), cancers and tumors (13.63%) and unintentional injuries (11.55%) in 2011. The 10 leading causes of death in the general population were myocardial infarction, stroke, transportation-related accidents; blood pressure induced heart disease, other cardiovascular diseases, diabetes, chronic pulmonary and bronchial diseases, gastric cancer, other heart diseases and renal failure.

Conclusion: Deaths from non-communicable diseases still account for a large proportion of total deaths. According to the Heath System Reform Plan in Iran and the need for new interventions, it is very important to register the exact causes of death to design service packages and also evaluate the success rate of ongoing interventions.

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Background and Objectives: Ischemic heart disases are the main cause of mortality and morbidity in Iran. Diabetes mellitus (DM) is one of the most prevalent diseases in Yazd. However, little is known about the share of CHD associated with DM in Yazd.This study aimed to determine the potential impact fraction of ischemic heart disease associated with diabetes mellitus in Yazd-Iran.
Methods: The potential impact fraction (PIF) equation was used to calculate the estimates of CHD associated with DM in Yazd. Prevalence diabetes in Yazd were calculated from Yazd Health Study (YAHS) data, conducted in 2013- 2014 in Yazd Greater Area. The relative risk eof IHD associated with DM was extracted from Tehran Lipid and Glucose study.
Results: According to this study, by hypothetical reduction of DM prevalence in women from the 20.6 percent to null or optimistically to a minimum risk level of 20.3 percent, 23.6% and 0.3% of IHD will be reduced consequently. The corresponding value for men considering the DM prevalence of 15.9 percent at the theoretical zero level and feasible minimum prevalence of 17.7 percent, were 10.6% and -1.2%, respectively.
Conclusion: Given the high prevalence of DM and CHD in Yazd, more interventions to control DM is needed in Yazd by the health section.

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Background and Objectives: Cholera is one of the public health ththat has received attention due to climate change and weather variables. In the current study, the trend of cholera and its epidemics was assessed in the last 50 years in Iran based on climatic variables.
Methods: In a retrospective cohort study, all cholera cases and epidemics of the disease in the country (Iran) were assessed using the registry system of the Center for Communicable Disease Control in the Ministry of Health and Medical education (MOH&ME) from 1964 to 2014. Furthermore, the incidence of cholera was evaluated in 2005-2014 by province. The temperature and rainfall data were obtained from the provincial Meteorological Organization. The correlation coefficient test and mixed-effects binomial regression model were used for data analysis.
Results: A significant positive correlation was found between cholera and rainfall (r = 0.168, P = 0.008). A one-millimeter increase in rainfall increased the incidence of cholera by 10.9% but temperature changes had no effect on cholera outbreaks. The incidence of cholera declined significantly by 14.7% each year from 2005 to 2014. The highest incidence of cholera was reported in Sistan-Baluchestan, Qom, Tehran, Kerman and Hormozgan provinces in a descending order.
Conclusion: In recent years, the the overall incidence of cholera has decreased. The occurrence of cholera is an outcome of rainfall in the previous year. Therefore, increased rainfall increases the number of cholera cases in the next year. However, temperature changes are not related to cholera outbreaks.

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Background and Objectives: Children’s well-being is a multidimensional construct that precedes various aspects of children's lives. This study sought to identify the main areas of children's wellbeing in Iran and their domains, components, and indicators that can be used to measure the well-being of children in Iran.
Methods: In this Delphi study, 30 experts that had educational, research, and executive experiences in various areas of children’s life were consulted. The dimensions, components, and indicators of children’s wellbeing were extracted through a review of the literature and views of the experts and children. The Delphi method was applied in three rounds. The dimensions and components with a higher-than-average score were selected and the percentage of Delphi members’ agreement with related indicators was measured.
Results: Generally, 25 components and 110 indicators related to 7 domains (physical health, safety and risks, economical situation, family, personal and social well-being, education, housing and living conditions) were selected by Delphi members. Consensus on the relevancy of indicators, proportionality, and comprehensiveness was 100%, 95%, and 86%, respectively.
Conclusion: The components and indicators suggested in this study can help to create a composite index for monitoring and comparing the status of the children’s wellbeing between different provinces of Iran in different times. It can also show the strengths and weaknesses of the policies and programs related to children’s wellbeing and help the government to adopt appropriate policies for the whole country as well as each province.

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Background and Objectives: This study assessed the validity and reliability of the Persian version of the standard "Problematic Internet Use" questionnaire to be used in epidemiological studies.
Methods: This cross-sectional study was performed in 2016. This questionnaire comprises five domains, including preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes. The questionnaire has 15 questions with a total score ranges from 15 to 105. A score of 15-45 indicates a normal state, a score of 46-65 shows a mild disorder, a score of 66-85 suggests a moderate disorder, and a score of 86-105 reveals a severe disorder.
Results: Three hundred and seven students (31.1%) had a normal score, 445 (45.1%) had a mild disorder, 191 (19.4%) had a moderate disorder, and 43 (4.4%) had a severe disorder. Based on CVR, 10 questions had a validity of 100%, 3 questions had a validity of 80%, 1 question had a validity of 40%, and 1 question had a validity of zero. The overall validity of the questionnaire was 85.3%. Based on alpha coefficient, the reliability of the domain of preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes was 87.6%, 91.1%, 89.8%, 90.8%, and 86.2%, respectively. The overall reliability of the questionnaire was 92.5%.
Conclusion: The validity and reliability of the questionnaire were high; thus, it can be used as a standard tool in epidemiological studies to explore the pathology of injuries related to the Internet and social networks.

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Background and Objectives: Identification of statistical models has a great impact on early and accurate detection of outbreaks of infectious diseases and timely warning in health surveillance. This study evaluated and compared the performance of the three data mining techniques in time series prediction of brucellosis.
 
Methods: In this time series, the data of the human brucellosis cases and climatology parameters of Hamadan, west of Iran, were analyzed on a monthly basis from 2004 (March/April) to 2017 (February/March). The data were split into two subsets of train (80%) and test (20%). Three techniques, i.e. radial basis function (RBF) and multilayer perceptron (MLP) artificial neural network methods as well as K Nearest neighbor (KNN), were used in both subsets. The root mean square errors (RMSE), mean absolute errors (MAE), mean absolute relative errors (MARE), determination coefficient (R2) and intra-class correlation coefficient (ICC) were used for performance comparison.
 
Results: Results indicated that RMSE (23.79), MAE (20.65) and MARE (0.25) for MLP were smaller compared to the values of the other two models. The ICC (0.75) and R2 (0.61) values were also better for this model. Thus, the MLP model outperformed the other models in predicting the used data. The most important climatology variable was temperature.
 
Conclusion: MLP can be effectively applied to diagnose the behavior of brucellosis over time. Further research is necessary to detect the most suitable method for predicting the trend of this disease.
 

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Background and Objectives: Prioritizing the list of required research, taking into account the real needs and problems of the health sector, provides a ground for justice; strengthens the link between research, action, and policy; and addresses the needs of vulnerable groups. The present study was done to formulate research priorities of Hamadan University of Medical Sciences using the opinions of experts in the field of health as a positive step towards proper allocation of research resources of the University to solve the problem.
 
Methods: In this study, the research priorities of Hamadan University of Medical Sciences in 13 domains during 2017 were ranked using 10 standard criteria according to the Essential National Health Research (ENHR) approach.
 
Results: Forty inter and intra beneficiaries were participated in this study. During the sessions, using group training techniques (brain storming), the topics were discussed, resulting in identifying 122 topics in 13 domains. In each of these domains, top 10 topics with the highest ranks were determined as the research priorities of Hamadan University of Medical Sciences.
 
Conclusion: Determination of research priorities at a provincial level based on the ENHR approach was conducted in Hamadan University of Medical Sciences with the cooperation of all health stakeholders for the first time. The result of this study will play an important role in optimum use of resources of the research and technology domain of Hamadan University of Medical Sciences by directing research projects according to the identified priorities.

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Background and Objectives: The Family Physician (FP) plan was implemented in rural areas and cities with a population of less than 20000 in 2005. The purpose of this study was to explain the challenges and obstacles of¬ the Rural Family Physician Program in Kurdistan Province from the perspective of stakeholders.
 
Methods: This qualitative study was conducted using 30 semi-structured interviews and 5 focused group discussions (FGD) with stakeholders of the FP plan from June 2017 to Jan 2018. The participants were selected through a purposive sampling method with maximum variation. The contents of the interviews and FGD were categorized by the content analysis method using MAXQDA10 software (V. 10).
 
Results: The challenges and obstacles of the FP plan were categorized into 16 subcategories and 5 main categories. The main categories were stewardship challenges, service delivery challenges, cultural and educational challenges, human resource challenges, and infrastructure challenges. The most important subcategories of these challenges included weaknesses in policy-making, formation of laws and regulations, weaknesses in insurance performance, weaknesses in intra-sector coordination, weaknesses in the referral system, weaknesses in communicating the plan to the community, low survival of physicians, inadequate motivational mechanisms, and weaknesses in the information system.
 
Conclusion: The rural FP plan faces many challenges that require multi-dimensional interventions. Identifying the challenges of the FP plan from the perspective of its stakeholders can help to gradually improve the plan.

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Background and Objectives: an important problem challenging cesarean section is its extensive use as a common method of delivery. Due to the growing trend of cesarean section in Iran in recent years, the natural delivery promotion program was implemented as one the programs incorporated in the Health System Reform Plan in 2014. In this study, the trend of changes in the percentage of CS delivery in Qom Province following the implementation of this program was evaluated.
 
Methods: This trend analysis that was performed in all cesarean deliveries in Qom Province from 2005 to 2018 using a joinpoint regression method.
 
Results: These results showed an annual increase of0.4% in the CS percentage 95% CI: -0.5 to  1.2), which was not statistically significant. A significant decrease was observed in the rate of CS in governmental hospitals. Conversely, in non-governmental hospitals, the percentage of CS increased significantly.
 
Conclusion: According to the findings of this study, after more than 3 years of implementation of health sector evolution plan, overall implementation of this plan failed to significantly reduce the overall process of cesarean delivery during this period in Qom province and achieve the predetermined goals.

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Background and Objectives: Iran started malaria elimination campaigns many years ago. The purpose of this study was to review the malaria surveillance system in Iran.
 
Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, a review of records, documents, books and published articles, and also interviews with process owners and experts of malaria surveillance in 2017-2019.
 
Results: The surveillance system of malaria in Iran has a coherent structure, in which all identified cases are reported and monitored from the environmental levels to the center by telephone instantly. Considering that the main goals of the malaria program including disease elimination have been obtained, the surveillance system in Iran is currently aiming at strengthening the elimination phase. In this stage, all new cases are also epidemiologically investigated in addition to examination, treatment and follow-up for categorization of the cases in categories of relapse, indigenous, introduced, and induced.
 
Conclusion: The successful implementation of the surveillance system for malaria over time has caused indigenous cases of disease to be limited to three southeastern provinces of the country and there are fewer than 300 new cases a year. Despite success, since the goal of malaria surveillance in Iran is now disease elimination, continuous monitoring of  correct implementation of all processes and evaluation of the applied strategies are necessary.

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Background and Objectives: As a result of the Covid-19 outbreak in Iran and other countries of the world, face-to-face training in schools and universities was changed to distance eductaion, which has had different consequences. The purpose of this study was to identify and categorize educational harms and challenges using existing measures and evidence from recent international data. The results of this study can be used to better understand the impact of the COVID-19 crisis on learners' learning as a practical and generalizable framework for epidemic management in the field of education in Iran and other countries.
 
Methods: The present qualitative study was performed using the document content analysis method. First, by reviewing electronic databases, all available documents and articles related to education and Covid-19 were identified. All multimedia files, including audio, text and video files during winter 1399 were searched in Internet websites and databases using keywords based on the above criteria. The selection of documents was purposeful considering the four criteria of JUPP. After multi-stage screening, 65 documents were finally selected and analyzed after coding.
 
Results: Educational harms and challenges caused by Covid-19 outbreak in Iran and other countries were identified and recorded in 29 areas.
 
Conclusion: It can be concluded that although online education is an immediate need in the process of learning and teaching with many benefits, proposing managerial and executive solutions to address the harms and challenges can form the basis of a rich method of eeducational ducation during and after the Covid-19 era.

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Background and Objectives: Reports indicates a higher mortality rate of Covid-19 in the elderly. A limited number of studies have been performed on elderly patients in Iran. In the present study, we investigated the clinical features and survival of elderly patients with Covid-19 in Baharloo Hospital, Tehran, Iran.
 
Methods: This retrospective cohort study was conducted on the data of elderly patients with Covid-19 admitted to Baharloo Hospital, Tehran, Iran. The data of the hospitalized patients were followed until discharge or death. Finally, survival-related factors were analyzed using Cox regression.
 
Results: A total of 522 patients were enrolled in the study, of whom 53.8% were male and 101 died. The mean age of the deceased was 76.3 years, with a standard deviation of 8.6 years. The most common clinical symptoms at the time of admission were respiratory distress (69.5%), cough (61.1%), and fever (51.1%). Cox regression results showed that the risk of death increased by 5% for each one-year increase in age. In addition, calcium supplementation reduced the risk of death by 35%.
 
Conclusion: The results of the present study showed that calcium supplementation could be associated with increased survival of the elderly and reduced mortality. Due to calcium insufficiency in the Iranian population and the protective role of calcium in Covid-19, this issue is essential in the elderly patients warranting further investigation in the future.