Journal of School of Public Health and

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People, government and Health Insurance organization’s (HIO) spend a great deal of mony each year in Health sector. They expect an effective and acceptable outcomes as well as wellutilization of all resources (including Human Resources). The goal of this article is studying the effects of managerial styles employed by Hospitals heads on operational indices among Iran’s public hospitals. The study is a cross- sectional one and data collected cross- sectionally. Study population includes 355 public hospitals which were divided in 3 categories as large (>400 bed) medium (200 – 400 bed) and small (<200 bed). A questionnaire was used for data collection and interviews also conducted for the same purpose. The questionnaire included question about styles of leadership as well as operational indices. Leadership types determined as lycert models (4 styles). Findings demonstrate the effects of Hospitals head’s leadership styles on increase of decrease of outcome indices among study population. A cording to the findings participatory management has had more positive effects on the indices than the 3 other styles had.

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Background and Aim: As the population of the world increases, it is essential that food production keep pace. It will be necessary not only to produce more food, but also to maintain this food so that it is safe and wholesome for human consumption. The purpose of this study was to investigate the rate of Coliform, Staphylococcus aureus, Mould, Yeast and other aerobic and mesophilic bacteria as contaminats of milk and milk products in Yazd province.
Material and Methods: In this study a total of 198 different samples including Milk (24.2%), Yoghurt (21.2%), Cream (12.1%), Cheese (18.2%), Ice cream (12.1%) and dairy powders (12.1%) were investigated by culture method and biochemical tests. Then obtained data were analyzed by SPSS and χ2 programs.
Results: On the basis of our findings, of the total samples, 136 cases (68.7%) were desirable, 48 cases (24.2%) acceptable and 14 cases (7.1%) undesrable. Microbial contaminants of undesrable samples were coliform (7.1%), Staphylococcus aureus (6.1%) and yeast (6.1%). Meanwhile, the results of χ2 Statistical analysis test, showed significant different between contamination rate and kind of Milk products (df = 5, χ2 = 17.75, P<0.005(.
Conclustion: It seems that despite the efforts, which have been done for prevention of food contamination in Yazd province, it is still considered as a threat for people Health.

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Background and Aim: With growing emphasis on cost containment, optimal use of resources and increased productivity, the health sector is now adopting an increasingly customer-oriented approach within its administrative and managerial structure. One way to assess hospital performance and service quality would be to measure the level of satisfaction in hospital inpatients, as this group comprises the principal users of medical services within any health care system.
Materials and Methods: In this descriptive-analytic study we explored the factors affecting patient satisfaction. Our sample consisted of 400 randomly-selected inpatients who answered the research questionnaire at the time of discharge. We used univariate statistical analysis to examine the effects of various factors on patient satisfaction. 
Results: Of a total of 13 variables that were analyzed, 9 showed a statistically significant relationship with the outcome variable. These were age, education, marital status, occupation, hospital where interview is performed, hospital type (specialized versus general), type of ward, costs borne by the patient, and system of payment.  
Conclusion: The strongest effects were observed for marital status, education, hospital type, type of ward, and cost borne by the patient. Results from this study could help to recognize the current flaws within the hospital management system and thus can aid decisions aimed at optimizing hospital services and maximizing patient satisfaction.

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Background and Aim: One of the most important responsibilities of managers is leadership. Leadership styles are the constant behavioral models used by managers when working with others in organizations. The main purpose in this research was gaining an insight into the leadership styles of hospital managers (manager and chief) and to see if there is relationship between managers and employers' personality traits and the style of leadership adopted by the hospital manager.
Materials and Methods: This was a cross-sectional study involving all the hospital managers and 385 hospital staff in the province of Qom. We gathered data through a questionnaire based on the Likert system. We thus recognized four different styles of leadership: Exploitive-Authoritative, Benevolent – Authoritative, Consultative, and Participative. Data were analyzed using the SPSS software package.
Results: 1-Overall, the managers’ leadership styles were found to be mostly of the consultative type but the staff regarded their managers’ style of leadership as mainly Benevolent – Authoritative, 2- There was no statistically significant relationship between the managers’ personal characteristics and their leadership styles, 3- There is a significant association between the staff members’ characteristics and their perception of the manager’s leadership styles.
Conclusion: The managers’ personal traits do not appear to have an effect on their leadership styles but the same traits in employees can have a bearing on how they perceive leadership in their managers.

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Background and Aim: Nowadays, community health and different methods for health service delivery are among the most important public health issues in many countries. Most developing nations are trying to establish a health care system capable of meeting their basic needs.Hospitals are the most important service delivery points, and they need skilled manpower and adequate equipment for efficient performance of their medical care and educational functions. Today, the health of the mankind is facing greater hazards and challenges than at any other time in history, and within this context, hospitals are supposed to provide service of the highest standards and with minimum delay. Emergency wards are the sections where these principles apply more than anywhere else. These are rightly regarded as the "heart" of any hospital and a quick, efficient workflow in the emergency room can literally save lives.
Material and Methods: This was a cross–sectional (descriptive/analytic) performed in 2005 to assess the structure, process & performance in the emergency wards of 12 teaching hospitals affiliated to Tehran University of Medical Sciences.
Results: 33.3% of the ward chiefs were women the rest were men they were all more than 30 years of age. The average rate for implementing proper managerial standards was 90.6%. The "manpower index" was 69.1%, and the "facilities & equipment" index was 44/5%. The "directions index" and "activities index" were 66.97% and 93.5%, respectively.
Conclusion: The findings show that there is a positive and significant relationship between standards of management at the emergency department and the facilities and equipment index. Also, there are positive correlations between the emergency department's "manpower and rules" index instructions, activities, and years of service in hospitals.

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Background and Aim: Hospitals are among the most important health and medical institutions responsible for promoting health, and provision of appropriate health services requires a healthy, hygienic and safe environment. This research was done with the aim of assessing the environmental health situation Qom hospitals in 2005.

Materials and Methods: This research is an applied descriptive - analytic study on hospitals in QOM Province. Data were gathered using survey and observation methods and a two-part questionnaire. The first part of the questionnaire consisted of 45 items covering demographic data on hospitals and hospital managers. The second part comprised 363 questions about the environmental health situation as well as diagnostic, treating and support services. The questionnaires were filled after validity and reliability tests in eight hospitals in Qom Province. For statistical analysis, we performed Mann-Whitney and Kruskal-Wallis tests and calculated Spearman's coefficient, using the software package SPSS.

Results: Poor environmental health was observed in 25% of the radiology wards, kitchens and laundries. The situation was assessed as "appropriate" in 12.5% of laboratories and central sterilization (CSR), 25% of emergency services, 50% of ICU wards and 71% of surgery and recovery rooms, and it was intermediate of the other wards. Overall, the level of compliance with the principles of environmental health was average, i.e. about 72.5 percent. Further analysis of data showed that the situation was better in private, non-teaching hospitals compared to government-run and teaching hospitals. However, environmental health was found to improve with an increase in the number of active hospital beds and the managers' experience in their current job. It declined with increasing hospital age and increasing age of the hospital managers.

Conclusion: Overall, the environmental health situation in Qom hospitals was found to be at an intermediate level. Hence, these hospitals have a long way to go before they can achieve the appropriate level of environmental health

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Background and Aim: Job enrichment is a method that has been used to increase employee satisfaction and work motivation. The Hackman and Oldham job characteristics model (1976) has served as the foundation for many job enrichment efforts. In particular, a considerable amount of research has been devoted to the study of the job characteristics-job satisfaction relations. Te purpose of this study was to statistically determine the relation between job characteristics and job satisfaction among employees of hospitals affiliated to Tehran University of Medical Sciences (TUMS) in 2007.
Materials and Methods: This study was a cross-sectional one, including 6 TUMS-affiliated hospitals-Emam, Shariati, Baharlo, Ziaeian, Madaen and Azadi. The sample size was 400, consisting of 200 administrative employees (50%), 151 nurses (38%) and 49 physicians (12%). The random sampling and stratified proportional sampling methods were used to select the hospitals and interviewees, respectively. Two questionnaires were developed and used to identify job characteristics and job satisfaction: 1) job diagnostics surveys (JDS) and 2) Hertzberg's job satisfaction questionnaire. The reliability of the questionnaires was ascertained by test-retest using the Pearson correlation coefficient (r = 0.88). Linear-by-linear association and ordinal logistics regression analysis were used for analyzing the data gathered.
Results:The relations between the Motivational Potential Score (MPS) and job characteristics (except for feedback) with job satisfaction were statistically significant (p<0.05). Task identity was the most effective determinant of job satisfaction.
Conclusion: It appears that all the job characteristics (except feedback) are important determinants of job satisfaction of the hospital employees. Although the work environment is in need of restructuring, it is important to note, from a positive perspective, that the job characteristics discussed in this study are readily amenable to change job satisfaction at the organizational level.

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Backgrounds and Aim: One of the remuneration methods in the hospital system in Iran is per case, based on a classification system termed Global system (GS). The GS, supported by Iran's Ministry of Health and Medical Education (MOHME), was established in 1999 and is now used for cost reimbursement in the second- and third-levels of health care services. In this system, patients are classified into 60 categories, based on the most frequent surgical operations. However, it now appears, that there are many questions about this system. This study aims to compare the global operations reimbursement rates with actual costs in the Cancer Institute, Tehran, in 2003 and 2004.
Materials and Methods: This survey was a retrospective, analytical-descriptive one aiming at comparing the global operations reimbursement rates with actual costs in 646 global operations carried out in the Cancer Institute in 2003 and 2004. The global-operations and actual-costs data were gathered from Hospital Information Systems (HIS) and High Council of Insurance annual regulations, respectively, and analyzed using SPSS 11.5 software and the Wilcoxon non-parametric test.
Results: The differences between the cost reimbursement rates of global operations and their actual costs were lower in 2004 as compared to those in 2003. Also, the actual costs of operations were higher than the global operations reimbursement rates in both years and the difference was significant statistically in either year (P<0/001).
Conclusion: Some of the MOHME and Cancer Institute's authorities and experts believe that the decrease in differences between the cost reimbursement rates of global operations and their actual costs in 2003 compred to 2004 is due to increased awareness of physicians and the accounting and discharge units' personnel of the global operations and related regulations, as well as increasing global operations reimbursement rates. Also, they believe that the differences between the global operations reimbursement rates and their actual costs in either year could be attributed to not considering the actual inflation rate, hospital types, patients' co-morbidities, etc. in calculating the global operations reimbursement rates. It is suggested to make more realistic calculations, taking into account such variables as the actual inflation rate, hospital types, patient co-morbidities, etc.

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Background and Aim: Hospital disaster-management planning and preparedness are essential, considering earthquake threats in Iran. The objective of this study was to assess preparedness of hospitals affiliated to Iran University of Medical Science (IUMS) in Tehran against earthquakes in 2007 (1386 Iranian year).

Materials and Methods: This was a cross-sectional, descriptive-analytical study, involving 21 governmental and private hospitals affiliated to IUMS selected by random sampling. Data were gathered using checklists, questionnaires, interviews, and observation. The SPSS software was used for analysis of the data, and the Fisher exact test was employed for statistical analysis.

Results: The data showed that, on the whole, 28.6 %, 61.9 %, and 9.5 % of the hospitals were at a weak, moderate, and good preparedness level, respectively. The hospitals preparedness level with regard to equipment safety and hazardous materials planning increases with their degree of specialization, the association being statistically significant (p = 0.038). The findings also show that there is a significant relationship between the hospital preparedness level (as regards planning for building dangers reduction) and crisis management training courses (p = 0.034).

Conclusion: Training courses are very effective for creating hospital preparedness against earthquakes.

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Background and Aim: Factors determining the health care-seeking behaviors of an individual are social, cultural, and economic (treatment costs). Utilization of a health care system by a person will, on the whole, depend mainly on the socio-economic and demographic factors, cultural beliefs and practices, gender discrimination and women's status, the economic and political systems, environment, patterns of illness, and the health care system itself. The main objective of the present study was to examine current patterns of health care-seeking behavior in residents of Tehran, Iran in 2007.

Methods and Materials: In a cross-sectional study a two-stage cluster sampling method was used to select neighborhoods at the first stage and households at the second. The sample included a total of 1882 individuals over 18 years old in the households. The data were collected using a questionnaire. For analysis of the data the exact fisher test, X2, and multivariate logistic regression were used the software used was SPAA.3

Results: About 22/9% (431 persons) of the participants reported 1-2 illnesses during the previous month. Multivariate logistic regression indicated that age, sex, perceived severity of the illness, educational level, and marital status were all statistically associated with an attempt to seeking care, whether self-treatment or consulting a health center. The effects of different variables on decisions related to seeking care from a health care center versus self-care were also examined. The data showed that age, sex, perceived severity of the illness, income, educational level, household size, and method of payment were statistically the most significant variables affecting seeking care from a health center.

Conclusion: Based on these findings, it may be concluded that increasing social awareness about side effects of medicines, potential dangers of self-treatment, continuous education and training of physicians and pharmacists, improving health insurance systems and universal insurance coverage will be appropriate strategies for better utilization of health care services by the people.

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Background and Aim: By providing the greatest amount of direct service to patients, nurses play an extremely valuable and unmatched role in the quality and efficiency of care and curative services. Workplace violence is regarded as one of the factors which can reduce job satisfaction and the quality of working life of nurses and their interaction with patients, as well as the work efficiency of nurses and hospitals. In this study, after translating and validating tools of violence measurement in the health sector, the exposure of nurses to psychological violence was measured in a large teaching hospital in Tehran

Methods and Materials: A descriptive-cross sectional design was used in this study in summer of 2009 (1387). The study population included all the nurses (n=413) working in a large teaching hospital in Tehran. The questionnaire used for collecting data was adopted from a standardized questionnaire designed jointly in 2003 by the International Labor Office, the World Health Organization, the International Council of Nurses, and the Public Services International. Analysis of the data was made using the descriptive statistical methods and the Chi square- and t-tests.

Results: Sixty-nine percent of the nurses had experienced workplace violence. The most common forms of violence were verbal abuse (%64) and bullying-mobbing (%29). On the whole, 26% of the nurses had experienced both forms of violence in the previous year, while 335 had not faced any form of violence in their workplace. Nurses working in outpatient clinics and emergency wards experienced the highest number of encounters with verbal abuse. Encounters with bullying and mobbing were more common among female nurses than the male ones. Overall most of the violent behaviors were committed by patients and their relatives.

Conclusion: Exposure of nurses to psychological violence is considerable and comparable to that reported by previous investigators in other countries. Thus it is highly crucial to adopt appropriate management policies aiming, particularly, at educating the medical personnel in ways of preventing and reporting violent behaviors.

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Background and Aim: Organizational centralization, an important concept/system in management, relates to hierarchy of authority and degree of participation in decision-making. In this study we aimed to determine the extent of organizational centralization in hospitals affiliated with Tehran University of Medical Sciences (TUMS), Tehran, Iran and identify factors affecting the organizational centralization at the level of executive managers.

Methods and Materials: All the managers and head nurses of 13 TUMS hospitals (26 subjects) were included in this cross-sectional study in 2005. Data, collected using questionnaires, were analyzed using the following tests: t-test, ANOVA, Pearson and Spearman, the software being the SPSS. The extent of organizational centralization was categorized into centralized, semi-centralized, and uncentralized.

Results: Five of the 5 variables studied were statistically significantly associated with organizational centralization. They were gender (p=0.001), organizational position (p=0.005), attending management courses (p=0.001), and financial burden of decisions (p=0/03) in the hospital managers group, and possibility of controlling the decision (p=0.014) in the head-nurses group.

Conclusion: The average organizational centralization in the hospitals was 75.38% it was 76.3% and 73.38% for hospital managers and head-nurses, respectively. On the whole, the management system of TUMS hospitals is a semi-centralized system.

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Background and Aim: Domestic violence against women is a serious public health problem and women adopt different solutions to fight against it. This study was carried out to determine the prevalence of intimate partner violence and views of women
on adopting ways to fight against it in Arak city, Iran, year 2008.

Methods and Materials: In a cross-sectional study in Arak city in 2008, a total of 1037 women were interviewed. The data collected were analysed statistically.

Results: Findings showed that the common types of abuse were emotional (64.6%), verbal (57.1%), financial (32.3%), and physical (26.8%). The women mentioned that the most efficient ways they chose to counteract the abuses were as follows: resuming talking after the settlement of quarrels (93%), keeping silent on the part of one of the partners (81%), and seeking advice from the older members of the family (81%). The considered going into a temporary sulk (51%) and reciprocation (46%) ineffective methods. Correlations were found between violence on the one hand and education, job, addiction of the spouse, income of the spouse, mental disorder of the partner, and number of children on the other hand (p<0.05).

Conclusion: Results of this study show that a large number of women are subjected to different types of violence. It seems that increasing awareness of married women and girls concerning effective counteractive methods can be an effective step in solving this social problem.

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Background and Aim: Despite the fact that the proportion of youth population is very high in Iran, there is no well designed, comprehensive reproductive health program for the youth. This prompted the health planners to evaluate all the existing centers that deliver reproductive health services to the youth in the country in order to identify the weaknesses and strengths of the services and the centers.

Materials and Methods: A descriptive analytic study was conducted from March 2006 to March 2007, in coordination with the Vice-chancellor for Health of Universities of Medical Sciences, through Offices for Health of the Youth and Schools (OHYS). Five health centers, namely, Tehran, Semnan, Bam, Chabahar, and Fassa Health Centers (the only centers delivering reproductive health services to the youth) were included in the study. They were assessed for structure and physical facilities, job satisfaction of the personnel, satisfaction of the youth consulting them, and the services (including consultative services) delivered. The data were gathered through questionnaires using a checklist and analyzed by the SPSS-13 software.

Results: The health center personnel thought that the quality of services delivered at the centers was low. They also believed that the physical facilities, including equipment in the clinical examination room, furniture, cleanliness of the premises, and entertainment facilities, were not of an acceptable standard. About 64% of the personnel of the health centers personnel expressed job satisfaction. On the other hand, 39% of the young people consulting the centers expressed full, and 54% relative, satisfaction with the services they were receiving the remaining 7% were not content at all. The highest rate of satisfaction was with the psychologist, physician, and midwife, so that 95% of the clients recommended the centers to other young people seeking reproductive health services. Finally, the clients said that in most of the centers paramedical personnel, including nutrition officers (50%) and midwives with a Master's degree (17.5%), were insufficient.

Conclusion: It is suggested that a comprehensive service package be developed to be used in all the health centers, rather than each center deliver services based on the existing facilities and individual preferences. Such a package should be based on the national reproductive health programs (according to the medical education curricula). Intersectoral collaboration (particularly from the Ministry of Education and cultural organizations) is also very essential.

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Background and Aim: Patients who consult hospital due to physical or mental damages have legal rights. Observation of patients' rights will result in patient satisfaction, which will help to improve hospital services. The aim of this study was to determine awareness and observation of patient's right in hospitals affiliated with medical universities in Tehran.

Materials and Methods: This was a cross-sectional study conducted in 2009 in hospitals affiliated with medical universities in Tehran. A total of 601 patients were randomly selected from 11 hospitals affiliated with three medical universities in Tehran. Data were collected using a 50-item questionnaire the validity and reliability of which had been confirmed. Chi-square and Kruskal-Wallis tests were used for statistical analysis. The software used was SPSS.17.

Results: The mean age of the patients (59% females and 41% males) was 43.3 (SD=18.5) years and the average length of hospitalization 7.1 (SD=7.4) days. Data analysis showed that the proportions of the patients with a poor, intermediate and desirable patients' rights awareness were 71.5%, 22.0% and 5.8%, respectively. Observation of patients' rights was good in 13.8% of the cases, medium in 82.9% of the cases and poor in 3.3% of the cases. There was a significant statistical relationship between observation of patients' rights on the one hand and the hospital ward and length of stay on the other hand (p=0/007). Further analysis of the data showed that the strongest and the weakest observed rights were patient awareness right and the right of making objections and lodging complaints, respectively.
Conclusion: The results of this study showed that patients are not well aware of patients' rights and that observation of patient's rights is not at a desirable level. We recommend organizing public educational programs including components on patients' rights and follow-up of patient' rights violations, as well as passing a comprehensive act to ensure observation of patients' rights and specific programs designed for monitoring and supervising it.

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Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression.

Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant.

Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05).

Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources.

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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Background and Aim: The quality of working life is a very important variable in connection with human resources. Therefore, it should be taken into consideration by managers if they aim to improve the capabilities and efficiency of their staff, which will, in turn, lead to improved productivity and economic growth. Productivity is an important factor in the success of hospital nurses too. The objective of this study was to determine the association between the quality of working life and productivity of nurses. Knowledge of this relationship can help plan to improve the nurses' quality of working life and, subsequently, improve their productivity and, ultimately, productivity of a hospital.

Materials and Methods: This was a cross-sectional correlation study conducted in 2011. The study population was nurses of the Shahid-Beheshti University of Medical Sciences hospitals in Tehran, Iran. Using the randomized stratified multistage sampling method, 380 nurses were selected as the study sample. Data on the nurses' quality of working life and productivity were collected using two questionnaires and analyzed using SPSS-17, the statistical tests being Chi-2, ANOVA, T-test, and the Pearson correlation test.

Results: The findings showed that nurses' quality of work life and productivity were at the middle level, with a mean of 2.47 and 3.07, respectively.  A very small number (1.55%) of the nurses reported that their quality of work life was at a high level, while the majority (82.4%) believed their quality of work life to be at a moderate level. The Pearson correlation test showed a significant positive relationship between the quality of work life and productivity of the nurses (r = 0.66, p-value = 0.001).

Conclusion: Only a low proportion of the nurses report their quality of working life and productivity to be at a high level. Therefore, bearing in mind that a statistically significant relationship exists between the quality of working life and productivity, authorities should atempt to promote the nurses' quality of work life in order to increase their productivity.

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  Background and Aim: Social loafing is the phenomenon of people deliberately exerting less effort to achieve a goal when they work in a group as compared to when they work alone. People who feel they are being treated unfair in an organization would be more likely to show this phenomenon. This study investigated the social loafing among nurses and its relationship with organizational justice in Tohid Hospital in Sanandaj, Iran.

  Materials and Methods: This was a correlational descriptive-analytical study conducted in 2012. The study population was all nurses working in Tohid Hospital in Sanandaj, Iran. Data were collected using a valid questionnaire. For data analysis SPSS-20 software was used, the descriptive statistics being frequency distribution, mean, standard deviation, and the Spearman, Mann-Whitney, and Kruskal-Wallis tests .

  Results : The highest organizational justice component was found to be organizational justice (0.086 ± 3.39), and the mean of social loafing was higher in comparison with organizational justice. According to the Spearman test, all organizational justice components had inverse relations with social loafing. Only distributive organizational justice was significantly related to social loafing (p<0.05).

  Conclusion: It can be concluded that the personnel are highly sensitive to distributive justice and managers need to create the feeling that the organization has a fair distribution of resources. Hospitals should try to minimize the negative effects associated with loafing by creating an environment that discourages social loafing. One way to achieve this goal is to try to impress the personnel by telling them that their functions are important , such that they feel their job is important and that the role of nurses in connection with the patients is of value and significant.

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  Background and Aim: A ssociations between air pollution and morbidity have been reported in several studies. Due to limited publications in the literature for Iran, this study aimed to determine the association between air pollution and hospital admissions of respiratory disease patients in Tabriz, Iran.

  Materials and Methods: The methodology used in this study was case -crossover and the artificial neural network model. The variables of the model included air quality, hospital admission and air pollutants. Daily hospital admission data were collected from five hospitals in Tabriz, Iran based on the International Classification of Diseases (ICD-10) , air quality data including NO₂, SO₂, CO, PM₁₀ and O₃ from the six fixed online air quality monitoring stations, and the daily mean temperature and relative humidity data for the same period from the East Azerbaijan Meteorological Bureau.

  Results : P articulate matter with a median aerometric diameter <10 μm (PM₁₀) was found to be the most important pollutant affecting respiratory hospital admissions. The ANNs data showed that the most important causes of hospital admissions were for COPD NO₂, NO and CO, for respiratory infections PM_10, and for asthma PM₁₀, O₃ and CO. The highest associations were observed between hospital admissions due to COPD and asthma in females and those due to respiratory infections in males. The elderly (individuals over 65 years old) were at the highest risk.

  Conclusion: The results show a significant relation between air pollutants and respiratory hospital admissions in Tabriz, Iran. The importance and necessity of enforcement of existing regulations and enacting laws to prevent and control the adverse health effects of air pollution are confirmed.