BackgroundHealth literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries.MethodsA cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013–2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis.ResultsThe questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity.ConclusionsThe HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

OBJECTIVEThe discrepancy of diabetes incidence and care between socioeconomic statuses has seldom been studied concurrently in nations with universal health coverage. We aimed to delineate whether income disparity is associated with diabetes incidence and inequality of care under a national health insurance (NHI) program in Asia.RESEARCH DESIGN AND METHODSFrom the Taiwan NHI database in 2000, a representative cohort aged ≥20 years and free of diabetes (n = 600,662) were followed up until 2005. We regarded individuals exempt from paying the NHI premium as being poor. Adjusted hazard ratios (HRs) were used to discover any excess risk of diabetes in the poor population. The indicators used to evaluate quality of diabetes care included the proportion of diabetic patients identified through hospitalization, visits to diabetes clinics, and completion of recommended diabetes tests.RESULTSThe incidence of type 2 diabetes in the poor population was 20.4 per 1,000 person-years (HR, 1.5; 95% CI, 1.3–1.7). Compared with their middle-income counterparts, the adjusted odds ratio (OR) for the poor population incidentally identified as having diabetes through hospitalization was 2.2 (P < 0.001). Poor persons with diabetes were less likely to visit any diabetes clinic (OR, 0.4; P < 0.001). The ORs for the poor population with diabetes to receive tests for glycated hemoglobin, low-density lipoprotein cholesterol, triglycerides, and retinopathy were 0.6 (0.4–0.9), 0.4 (0.2–0.7), 0.5 (0.4–0.8), and 0.4 (0.2–0.9), respectively.CONCLUSIONSPoverty is associated not only with higher diabetes incidence but also with inequality of diabetes care in a northeast Asian population, despite universal health coverage.

Purpose Corporate social responsibility (CSR) marketing has become ubiquitous in the hospitality industry. The purpose of this paper is to examine the effectiveness of donation appeals containing warmth-focused versus competence-focused messages in hospitality CSR marketing. Moreover, we offer an innovative visual design strategy focusing on the typeface (handwritten vs machine-written) in donation appeals to encourage consumers’ donations and boost their brand loyalty. Design/methodology/approach This research used a 2 (message framing: warmth-focused vs competence-focused) × 2 (typeface: handwritten vs machine-written) between-subjects experimental design. Findings The findings suggest that donation appeals featuring warmth-focused messages combined with handwritten typeface and competence-focused messages combined with machine-written typeface can maximize donation intention and brand loyalty. Furthermore, results from the moderated mediation analyses indicate that brand trust is the psychological mechanism underlying these effects. Practical implications Hospitality managers should use typeface design, which is easy and inexpensive to manipulate, to enhance the effectiveness of CSR marketing. Specifically, for donation appeals featuring warmth-focused (competence-focused) messages, the handwritten (machine-written) typeface can boost consumers’ donation intention and brand loyalty. Originality/value To the best of the authors’ knowledge, this research is the first to reveal the competitive advantage of typeface design in hospitality CSR marketing. This research sheds light on the congruency effects of message framing and typeface design in donation appeals on consumers’ donation intention and brand loyalty while using the contemporary context of The Coronavirus Disease 2019 to test the theory.

BackgroundSleep apnea (SA) has been associated with cognitive impairment. However, no data regarding the risk of dementia in patients with SA has been reported in the general population. This retrospective matched-control cohort study was designed to estimate and compare the risk of dementia in SA and non-SA patients among persons aged 40 and above over a 5-year period follow-up.MethodsWe conducted a nationwide 5-year population-based study using data retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan. The study cohort comprised 1414 patients with SA aged 40 years who had at least 1 inpatient service claim or 1 ambulatory care claim. The comparison cohort comprised 7070 randomly selected patients who were matched with the study group according to sex, age, and index year. We performed Cox proportional-hazards regressions to compute the 5-year dementia-free survival rates after adjusting for potentially confounding factors.ResultsThe SA patients in this study had a 1.70-times greater risk of developing dementia within 5 years of diagnosis compared to non-SA age- and sex-matched patients, after adjusting for other risk factors (95% confidence interval (CI) = 1.26-2.31; P < .01). For the gender-dependent effect, only females with SA were more likely to develop dementia (adjust HR: 2.38, 95% CI =1.51–3.74; P < .001). For the age-dependent effect of different genders, males with SA aged 50-59 years had a 6.08 times greater risk for developing dementia (95% CI = 1.96-18.90), and females with SA aged ≥ 70 years had a 3.20 times greater risk of developing dementia (95% CI =1.71–6.00). For the time-dependent effect, dementia may be most likely to occur in the first 2.5 years of follow-up (adjusted HR:2.04, 95% CI =1.35-3.07).ConclusionsSA may be a gender-dependent, age-dependent, and time-dependent risk factor for dementia.

Typhoon Morakot struck Taiwan during 6-9 August 2009, and it produced the highest rainfall (approaching 3000 mm) and caused the worst damage in the past 50 yr. Typhoon-monsoon flow interactions with mesoscale convection, the water vapor supply by the monsoon flow, and the slow moving speed of the storm are the main reasons for the record-breaking precipitation. Analysis of the typhoon track reveals that the steering flow, although indeed slow, still exceeded the typhoon moving speed by approximately 5 km h~'(l km h~' = 0.28 m s~') during the postlandfall period on 8 August, when the rainfall was the heaviest. The CloudResolving Storm Simulator (CReSS) is used to study the dynamics of the slow storm motion toward the northnorthwest upon leaving Taiwan. The control simulations with 3-km grid size compare favorably with the observations, including the track, slow speed, asymmetric precipitation pattern, mesoscale convection, and rainfall distribution over Taiwan. Sensitivity tests with reduced moisture content reveal that not only did the model rainfall decrease but also the typhoon translation speed increased. Specifically, the simulations consistently show a discernible impact on storm motion by as much as 50%, as the storms with full moisture move slower(~5 km h~'). while those with limited moisture (s25%) move faster (-10 km h"'). Thus, in addition to a weak steering flow, the prolonged asymmetric precipitation in Typhoon Morakot also contributed to its very slow motion upon leaving Taiwan, and both lengthened the heavy-rainfall period and increased the total rainfall amount. The implications of a realistic representation of cloud microphysics from the standpoint of tropical cyclone track forecasts are also briefly discussed.