Based on China's health-related policy documents,combining the development history of health concepts and quality management theories,the evolution of China's view of healthcare service quality is sorted out.Moreover,based on the objectives of payment reform and the possible impact on healthcare service quality,the focus of healthcare service quality evaluation in the context of health insurance payment reform is elaborated.It aims to explore the focus of medical service quality evaluation at the present stage,and to provide a reference for better utilization of the evaluation results to improve the quality of medical services.

Background Excessive radon exposure is considered the second risk factor for lung cancer. Since the opening of the subway in a city of Zhejiang Province, the exposure level of radioactive gas radon in subway stations and its impact on occupational health have become one of the important issues of public concern. Objective To monitor the radon concentration of subways in a city in Zhejiang Province and explore the effect of radon exposure on chromosome aberration and micronuclei in the working population. Methods A total of 55 vehicle control rooms of 55 stations affiliated to two different subway lines in a city were measured for one year; the 110 ticket offices and 55 security checkpoints from the same 55 stations were measured from 16 March to 14 June. The radon concentrations were compared by job types, subway lines, and seasons referring to Measurement methods for determination of radon in environmental air (HJ 1212-2021). Peripheral blood lymphocyte chromosome aberration and micronucleus analyses were conducted in 165 subway workers from monitoring sites for three different job types, then the influencing factors were analyzed. The detection methods were adopted from the standards of Test and assessment of chromosomal aberrations on occupational health examinations for radiation workers (GBZ/T 248-2014) and Standard for the method of micronucleus detection in lymphocytes on occupational health examination for radiation workers and exposure dose estimation (GBZ/T 328-2023). Results The radon concentration range of the target subways in Zhejiang Province was 10-320 Bq·m⁻³, all lower than the national limit (≤400 Bq·m⁻³). The differences in radon radioactivity levels among different lines, job types, and time segments were statistically significant (P<0.05). The rates of chromosomal aberration and micronucleus formation among the 165 subjects were 0.224% and 0.024%, respectively. There were significant differences in the rates of chromosome aberration and micronuclei among different jobs (vehicle control room, ticket office, security checkpoint) (P<0.05), but the abnormal rates were lower than the limits of the corresponding national standard. No significant correlation was found between jobs and chromosomal aberrations or micronuclei (P>0.05). Chromosome aberration and micronuclei varied by age, subway station seniority, and smoking (P<0.05). No effect of the above factors on chromosome aberration and micronuclei was observed by logistic regression (P>0.05). Conclusion The radon concentration in the target subway system is at a normal level. The rates of chromosomal aberration and micronucleus formation vary by jobs, but both are lower than the corresponding national limits. Therefore, radon exposure has not yet caused outstanding health impact on the subway workers.

Objective To investigate the operation status and service level of radiation occupational health inspection institutions in Zhejiang Province, China, and to provide a basis for administrative departments and quality management departments to develop policies. Methods The investigation data of radiation occupational health inspection institutions in Zhejiang Province were collected for descriptive analysis of the regional distribution, nature, and service qualification of the institutions. Results There were 27 radiation occupational health inspection institutions in Zhejiang Province. These institutions were located in 11 cities, of which 85.18% were public institutions and 14.72% were private institutions. For the physical examination workload of radiation workers in Zhejiang Province in 2021, general hospitals accounted for 75.90%, private institutions accounted for 4.51%, and occupational prevention and treatment hospitals accounted for 19.59%. In the radiation occupational health inspection institutions, the stand-alone and online software installation rates were 33.33% and 37.04%, respectively. A total of 26 986 individuals (82.97%) underwent chromosome aberration examination. The examination rates of thyroid color Doppler ultrasound examination and eye lens examination were 41.24% and 82.97%, respectively. Pre-job, on-job, and off-job physical examination accounted for 25.81%, 70.52%, and 3.67%, respectively. For radiation workers who underwent on-job physical examination, diagnostic radiology workers accounted for the highest proportion of 34.90%. The excellent, qualified, and unqualified rates of 27 radiation occupational health inspection institutions were 7.41%, 88.89%, and 3.70%, respectively. Conclusion The network of radiation occupational health inspection institutions in Zhejiang Province is well-established and located mainly in general hospitals, occupational prevention and control institutions, and private institutions. To enhance the quality and proficiency of occupational health examinations, it is imperative to prioritize self-improvement and management, reinforce law enforcement supervision, actively engage in blind sample assessments, and advance the application of information technology and standardized services.

Objective:To investigate the activity concentrations of 90Sr and 137Cs in water in Hangzhou urban area. Methods:From 2012 to 2020, Qiantang River water as an important drinking water source, tap water as direct drinking water for residents, and West Lake water in tourists crowded area were selected forwater quality monitoring with respect to conctnts of 90Sr and 137Cs. The activity concentrations of 90Sr and 137Cs in water samples, as collected in wet and dry seasons resepectively, were determined by radiochemical analysis, with the 137Cs to 90Sr activity ratios obtained. Results:From 2012 to 2020, the activity concentrations of 90Sr and 137Cs in tap water were (2.0±1.1) - (7.4±0.4) mBq/L and (0.45±0.06) - (7.1±0.6) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.07 to 2.40. The activity concentrations of 90Sr and 137Cs in Qiantang River were (3.7±1.1) - (17.0±4.4) mBq/L and (0.28±0.01) - (15.0±4.5) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.03 to 0.90. The activity concentrations of 90Sr and 137Cs in West Lake water were (2.2±0.5) - (11.0±2.0) mBq/L and (0.32±0.04) - (7.9±1.9) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.05 to 1.20. Conclusions:The activity concentrations of 90Sr and 137Cs in water in Hangzhou urban area were at the background levels, lower than the concentration limits, 10 Bq/L both for 90Sr and 137Cs recommended by WHO in the 4 th edition of Guidelines for Drinking Water Quality.

Objective:To investigate and analyze the level of the gross radioactivity, and its variation trend, in surrounding drinking water since the second phase expansion project at Qinshan Nuclear Power Plant was officially put into operation.Methods:From 2010 to 2022, the source water, factory water and tap water within 30 km of Qinshan Nuclear Power Plant were collected in the flood season (May) and dry period (October) every year. The total α and total β radioactivity concentrations in drinking water was measured and analyzed. The levels of total radioactivity in drinking water around different nuclear power plants in China and around non-nuclear power plant areas was compared.Results:The mean radioactivity concentrations of total α and total β were (0.021±0.019) and (0.204±0.058) Bq/L in source water, (0.010±0.005) and (0.185±0.056) Bq/L in factory water , and (0.012±0.007) and (0.170±0.058) Bq/L in tap water, respectively, all lower than the limits stipulated in the Sanitary Standards for Drinking Water. There were no significant differences in the monitoring result of betweem the three types of water samples both in the flood and dry periods ( P> 0.05). The total radioactivity level in drinking water around Qinshan Nuclear Power Plant site was close to that in drinking water around different nuclear power plants in China and around areas without nuclear power plants. Conclusions:Following the second phase of the expansion project officially being put into operation, the total α and β radioactivity level in drinking water around the Qinshan Nuclear Power Plant has been in a stable trend and lower than the guidance level given in national standard.

Objective:To investigate and analyze the radioactivity levels of 90Sr and 137Cs in drinking water and 137Cs in food after the installation of the first AP1000 nuclear power unit in China. Methods:From 2012 to 2019, four drinking water monitoring points around AP1000 nuclear power unit located at Sanmen nuclear power plant site were collected during the wet season and dry season, 90Sr and 137Cs and radioactivity concentrations were determined in drinking water. Local rice, cabbage, crucian and mullet were collected to determine the radioactivity concentration of 137Cs. Results:From 2012 to 2019, the radioactivity concentrations of 90Sr and 137Cs in drinking water were 1.2-9.8 mBq/L and 0.2-8.1 mBq/L, respectively. The radioactivity concentration of 137Cs in food were 1.1×10 -2-2.8×10 -1 Bq/kg, lower than the limits specified in the Limited concentrations of radioactive materials in foods (GB 14882-94). Conclusions:After the installation of the first AP1000 nuclear power unit in China, the radioactivity levels of 90Sr and 137Cs in drinking water and 137Cs in foods are stable, without environmental impact identified.

Objective:To investigate the data on death cause of residents around Sanmen nuclear power plant from 2015 to 2019.Methods:The data on death cause of residents in Sanmen county from 2015 to 2019 were collected, and the top 10 diseases in death causes ranking and radiation-related malignant tumors were analyzed.Results:The average mortality rate of residents in Sanmen county was 575.87 per 100 000 population from 2015 to 2019, lower than the national level and close to that in Zhejiang Province. The top 10 death causes remain unchanged, higher than 95.79% of total deaths. The mortality rate of malignant tumor increased from 159.23 per 100 000 population in 2015 to 191.51 per 100 000 population in 2019 (χ 2=15.889, P<0.05). There was no significant difference in the proportion of mortality from radiation-related tumor(leukemia and thyroid cancer) in Sanmen county in recent 5 years ( P>0.05). Conclusions:From 2015 to 2019, the death rates of residents in Sanmen county were relatively stable. The effects of the operation of the nuclear power plant on the health of the local residents need to be continuously monitored.

Objective:To investigate the relevant situation of the emergency departments (ED) of general hospitals at all levels in Zhejiang Province participating in the prevention and control of Corona Virus Disease 2019 (COVID-19), and to provide a reference for further improving the capacity of emergency services.Methods:A multi-center cross-sectional investigation study was jointly initiated by the Zhejiang Provincial Emergency Medicine Quality Control Center, the Emergency Medicine Branch of Zhejiang Medical Association, and the Emergency Physicians Branch of Zhejiang Medical Doctors Association. Before investigation, experts were organized to develop a special questionnaire. Then the ED of general people's hospitals or Chinese Medicine hospitals at the county/district-level or above were included and their participations in the prevention and control of COVID-19 epidemic between March 9, 2020 and March 15, 2020 were investigated. The collected information included: basic information of the hospitals; participation of ED in fever clinics; the number of COVID-19 patients admitted to ED; the situation of ED support to the anti-epidemic front-line; and the epidemic prevention facilities of ED, and the early supply of medical protective equipments.Results:A total of 181 hospitals from 11 prefectures and cities across the province were finally included, including 52 (28.7%) Grade-A tertiary hospitals, 45 (24.9%) Grade-B tertiary hospitals, 64(35.4%) Grade-A secondary hospitals, and 20 (11.0%) Grade-B secondary or lower hospitals. Among them, 93 (51.4%) were COVID-19 designated hospitals, and 49 (27.1%) had the ability to detect COVID-19 nucleic acid; 177 (97.8%) set up independent fever clinics and 33 (18.6%) were managed by ED alone or mainly. The medical staffs of 65 (36.7%) fever clinics were all or mainly from ED. A total of 213 cases of COVID-19 were received/treated in 40.3% ED, accounting for 17.3% of the total number of cases in Zhejiang Province. A total of 3 848 doctors and nurses supported the front-line of epidemic prevention, of them, 253 supported Hubei Province (accounting for 12.5% ??of the total number). There were 68.5% and 76.8% ED having spare separate clinic and ordinary rescue single room to deal with the COVID-19. In addition, at the early days of anti-epidemic, more than 50% ED were in short supply or even had no medical protective equipment.Conclusions:The ED of Zhejiang Province plays an important role and has made a great contribution to the prevention and control of the COVID-19 epidemic. It is necessary to improve the conditions of ED to effectively respond to the prevention and control of daily infectious diseases.

Objective:To investigate the levels of gross radioactivity in drinking water and of 90Sr in food around Sanmen nuclear power plant (NPP) before and after operation. Methods:From 2012 to 2019, 7 drinking water monitoring sites were selected around the Sanmen NPP to collect source water, factory water and peripheral water, respectively, in order to measure and analyze the total radioactivity level in drinking water. Based on the dietary habits of local residents, 4 kinds of food such as grains, vegetables, freshwater fish and marine fish grown locally were sampled to measure and analyze the activity concentration of 90Sr. Results:Before the operation of Sanmen NPP, the total α radioactivity and total β radioactivity in drinking water around the NPP were 0.001-0.063 Bq/L and 0.019-0.210 Bq/L, respectively. After operation, the total α radioactivity and total β radioactivity were 0.001-0.084 Bq/L and 0.025-0.079 Bq/L, respectively. Both were lower than the national standard value given in the GB 5749-2006 " Sanitary standards for drinking water" . There was no significant change in the radioactivity level of source water, factory water and peripheral water during the wet and dry periods. The activity concentration of 90Sr in these four types of food ranged from 0.037 to 1.216 Bq/kg before operation and from 0.049 to 0.692 Bq/kg after operation, all lower than the standard value of " Standard for the concentration in radioactive substances in food" (GB 14882-94). Conclusions:Before and after the operation of Sanmen NPP, the total α and total β radioactivity in drinking water and 90Sr activity concentration in food are stable, below the national standard limit.

Objective: To investigate the contents of radionuclide ¹³⁷Cs in seafood from coastal areas of Zhejiang province, and to estimate the annual committed effective dose to population in different regions from ingestion of ¹³⁷Cs in seafood. Methods: Three representative monitoring areas were set on the coastaline of Zhejiang province, and the locally popular seafoods were selected as monitoring objectives. The contents of radionuclide ¹³⁷Cs were detected using HPGe γ spectrometry. The committed effective doses were estimated based on monitoring results and consumption data on seafoods in Zhejiang. Results: The detection ratio of ¹³⁷Cs in seafood produced on coastal areas of Zhejiang province was estimated to be 35.3% (36/102). Specific activity detected ranged from 0.004 to 0.140 Bq/(kg, Wet). Committed effective doses from ingestion of ¹³⁷Cs in one year to the population in island region, coastal region and inland region were 3.03×10^-5, 1.63×10^-5, 3.38×10^-6 mSv, respectively, far lower than the world committed effective dose resulting from internal exposure. Conclusions At present, the content level of ¹³⁷Cs in seafood produced on the coastal areas of Zhejiang province is much lower than the national standard limit, and the dose burden to the population is very minor with no health impact to the population.