Objectives To assess the real-world effectiveness and safety of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2D) and heart failure (HF) and to evaluate the associated risks of adverse events. Design A retrospective cohort study using propensity score analysis to control confounding variables. Setting Data were collected from the electronic health records of two large tertiary care hospitals in Thailand over a 12-year period (2010–2022). Participants Adults aged 18 years and older with a diagnosis of T2D and HF were included in the study. Patients who received SGLT2i for a minimum of 3 months were compared with those in a non-SGLT2i group. Participants with a diagnosis of HF that preceded their diagnosis of T2D were excluded from the analysis. Primary and secondary outcome measures The primary outcome was heart failure hospitalisation (HFH). Secondary outcomes included non-fatal stroke, non-fatal myocardial infarction (MI), all-cause mortality and adverse events (urinary tract infections, hypoglycaemia and acute kidney injury). Results A total of 11 758 patients were included in the study, with a median follow-up of 2.44 (IQR: 0.72–5.02) years. After applying inverse probability of treatment weighting, covariates were balanced, ensuring the validity of the treatment effect model’s assumptions. SGLT2i use was associated with a 59% reduction in HFH (HR 0.41, 95% CI 0.28 to 0.61), a 54% reduction in stroke (HR 0.46, 95% CI 0.33 to 0.63), a 51% reduction in MI (HR 0.49, 95% CI 0.36 to 0.67) and a 76% reduction in in-hospital all-cause mortality (HR 0.24, 95% CI 0.14 to 0.42). Additionally, SGLT2i use was associated with fewer adverse events, including lower rates of urinary tract infections and hypoglycaemia, compared with the non-SGLT2i group. Conclusions SGLT2i significantly improved cardiovascular outcomes in patients with T2D and HF in a real-world clinical setting. These findings support the incorporation of SGLT2i in the management of high-risk patients with T2D and HF. Further research is warranted to explore long-term outcomes and barriers to SGLT2i prescription in routine practice.

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014–2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05–1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands’ health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers’ observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals’ quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

International trade has become more complicated and is now related to more aspects of health and the health system. As Thailand is active in international trade and health, understanding what knowledge exists and determining the knowledge gap is essential for generating the necessary evidence in order to promote better understanding and allow evidence-based policy decisions to be made. This study reviewed the existence of knowledge on international trade and health issues in a scoping review, focusing on Thailand during the period 1991–2020. In total, 156 studies from seven databases and manual searching were included. Of these, 46% were related to trade in health services and 39% were linked to intellectual property, particularly access to medicines. This review found only a very small amount of research on other issues and did not identify any study on trade policies or products related to health and international trade and the environment. We therefore recommend that further studies should be carried out to provide more critical evidence—in particular, more research focusing on the impacts of trade on health-related goods and the analysis of the positive and negative impacts of international trade on industry is needed. Furthermore, better knowledge management through the publication of research findings and making them searchable on international databases will increase the visibility of international trade, increase our knowledge of health issues, and provide supporting evidence.

Background Stroke survivors, especially working-age adults, face an increased risk of recurrent stroke within one to five years after the initial occurrence, primarily due to suboptimal risk factor management. This study aims to investigate the contributing factors associated with the risk of recurrent stroke in this demographic. Methods This case-control study matched participants with recurrent stroke to those without recurrent stroke by age and gender. Multivariate logistic regression analyses were conducted to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to identify significant factors associated with recurrent stroke. The study included 100 patients with recurrent stroke and 200 control participants recruited from the hospital database. Results Significant factors associated with recurrent stroke were gender (OR, 1.83; 95% CI, 1.10 to 3.29), high fasting blood sugar (OR, 3.70; 95% CI, 1.10 to 3.29), drinking status (OR, 3.63; 95% CI, 3.01 to 6.54), sedentary lifestyle (OR, 2.77; 95% CI, 1.50 to 5.13), and lack of workplace support for health (OR, 2.02; 95% CI, 1.13 to 3.63). The association of female gender, marital status, smoking status, sedentary lifestyle, interpersonal relationships at the workplace, and workplace support for health with recurrent stroke differed by age group. Conclusions This study highlights the importance of addressing lifestyle-related and occupational factors to reduce recurrent stroke risk among working-age adults. Tailoring age-specific stroke prevention strategies, promoting healthier lifestyles, and implementing evidence-based interventions can lead to improved stroke outcomes and enhance the quality of life for this vulnerable population.

Background Stroke survivors, particularly those of working age, are at an increased risk of recurrent stroke within one–five years of the initial event, largely due to suboptimal management of risk factors. This study aimed to identify lifestyle and occupational factors associated with recurrent stroke in this demographic population. Methods This case-control study included 100 patients with recurrent ischemic stroke and 200 ischemic stroke survivors without recurrence, who were recruited from the hospital database. Multivariate logistic regression was used to identify significant factors associated with recurrence, which were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results The mean age was 45.4 years (SD = 15.1) among cases and 50.6 years (SD = 6.5) among controls. The male-to-female ratios were 1.17:1 and 1.94:1 in the case and control groups, respectively. Significant factors associated with recurrent stroke included female sex (aOR: 1.83; 95% CI [1.10–3.29]), high fasting blood sugar (aOR: 3.70; 95% CI [1.66–8.27]), current alcohol consumption (aOR: 3.63; 95% CI [2.01–6.54]), sedentary lifestyle (aOR: 2.77; 95% CI [1.50–5.13]), and lack of workplace support for health (aOR: 2.02; 95% CI [1.13–3.63]). The associations between these factors and stroke recurrence varied according to the age group. Conclusions This study highlights the critical role of modifiable lifestyle and occupational factors in stroke recurrence among working-age adults. Tailored age-specific prevention strategies—emphasizing physical activity, reduced alcohol use, and improved workplace health environments—may reduce the risk of recurrence and enhance health outcomes in this population.