Search Results for: GPG: Versione 5.6.2.1 (Aprile 2021)

Purpose
Children living with respiratory support rely on medical technology, either fully or partially, throughout the day to meet their breathing requirements. Although children and young people living with respiratory support at home undergo long-term treatments and make extensive use of health and social care services, there is a notable absence of comprehensive outcome data on this group. The establishment of the first nationwide Course of DISease reported to the Swedish CPAP Oxygen and VEntilator RegistrY paediatrics cohort aims to investigate the disease trajectory, clinical and socioeconomic risk factors influencing incident illness, hospitalisation risk and mortality among children living with respiratory support.

Participants
Data on patients aged 0–18 years reported to the Swedish National Registry for Respiratory Failure and Sleep Apnoea (Swedevox) 1 January 2015 to 29 July 2021 were merged with seven quality or governmental registries, the National Quality Registry for Intensive Care, the National Medical Birth Register, the Swedish Cause of Death Registry, the Registry for Interventions under the Act on Support and Service to Certain Disabled Persons, the Swedish National Patient Registry and with socioeconomic data from Total Population Registry and Longitudinal Integrated Database for health insurance and labour market studies.

Findings to date
The cohort includes 716 children, 59% male, who began respiratory support at an average age of 6.4 years (SD 5.4). Among them, 28% use continuous positive airway pressure, 64% long-term mechanical ventilation (LTMV), 3% high-flow oxygen therapy (HFOT) and 5% other methods. Respiratory support is mostly used at night, but many LTMV (54%) and HFOT (81%) users need daytime aid. 77% of LTMV users rely on mask connection, differing from international data.

Future plans
Future projects include exploring the impact of socioeconomic factors on hospitalisation rates and mortality. The dataset is due for an update in 2026.

Objectives
To evaluate if 10 sessions of hyperbaric oxygen treatments (HBOTs) improve short- and long-term health related quality of life, symptoms and physical performance in long covid patients compared with placebo.

Design
Parallel, randomised, placebo-controlled, double-blind trial.

Setting
Single-centre, university hospital, Sweden.

Participants
Previously healthy subjects aged 18–60 years, diagnosed with long covid were included. We excluded pregnant women, patients with RAND-36 (role limitations due to physical health (RP) and physical functioning (PF)) above 70, diabetes, hypertension and contraindications for HBOT.

Interventions
Subjects were randomly assigned to 10 sessions of HBOT or sham (placebo) treatments over 6 weeks. HBOT involved 100% oxygen, 2.4 bar, 90 min, placebo medical air, 1.34–1.2 bar. Randomisation (1:1) was done electronically, in blocks stratified by sex and disease severity. Subjects and investigators were blinded to allocation.

Primary and secondary outcome measures
Primary endpoints were changes from baseline in RAND-36 PF and RP at 13 weeks. Efficacy was analysed on an intention-to-treat basis. Harms were evaluated according to the actual treatment given.

Results
Between 15 September 2021 and 20 June 2023, 80 subjects (65 women, 15 men) were enrolled and randomised (40 in each group). The trial is completed. The primary endpoint analysis included 79 subjects (40 in HBOT and 39 in control). At 13 weeks, both groups showed improvement, with no significant difference between HBOT and placebo in PF (least square mean difference between groups (LSD), 0.63 (95% CI –7.04 to 8.29), p=0.87) and RP (LSD, 2.35 (95% CI –5.95 to 10.66), p=0.57). Harms: 43 adverse events (AEs), most commonly cough and chest pain/discomfort, occurred in 19 subjects (49%) of the HBOT group and 38 AEs in 18 subjects (44%) of the placebo group, one serious AE in HBOT and one death in the placebo group.

Conclusions
10 HBOT sessions did not show more short-term benefits than placebo for long covid patients. Both groups improved, with a notable sex difference. HBOT has a favourable harm profile.

Trial registration number
ClinicalTrials.gov (NCT04842448), EudraCT (2021-000764-30). The trial was funded by Vetenskapsrådet (2022-00834), Region Stockholm (2020-0731, 2022-0674), Hjärt-Lungfonden and OuraHealth Oy.

Objective
To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).

Design
A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.

Setting
37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).

Participants
Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.

Results
HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimised GeneXpert cartridge use by prioritising GeneXpert testing for TB risk groups and diagnosed TB by microscopy, chest X-ray and sputum pooling method. Moreover, they extended drug refill schedules to minimise the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.

Conclusion
COVID-19 disrupted TB commodity availability and TB treatment-seeking behaviour. Adaptations like multi-month drug refills and optimised GeneXpert use supported the TB healthcare system’s resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Program could consider adapting these practices postpandemic, with appropriate modifications to suit different contexts.

Objective
This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden.

Design
A 1 year follow-up panel cohort observational study—the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February–May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March–May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey.

Setting
Swedish primary and specialist healthcare.

Participants
At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up.

Primary and secondary outcome measures
ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment Tool (BAT-23) was used to measure burnout, including a burnout total score and scores for the four symptom dimensions of exhaustion, mental distance, emotional impairment and cognitive impairment. Depressive symptoms were assessed using the Symptom Checklist-core depression (SCL-CD6). Associations between baseline burnout and depressive symptoms and subsequent ACMCSA were estimated with logistic regression analyses.

Results
ACMCSA was found in 9% of the participating physicians. In the sample, 4.7% had severe burnout complaints, and 3.7% had depressive symptoms. Burnout (OR=2.57; 95% CI=1.27 to 5.23) and the burnout symptom dimensions emotional impairment (OR=1.80; 95% CI=1.03 to 3.15) and cognitive impairment (OR=2.52; 95% CI=1.12 to 5.50) were associated with a higher likelihood of subsequent ACMCSA. Depressive symptoms were not associated with ACMCSA when adjusted for severe burnout complaints and other covariates.

Conclusion
This study demonstrates the distinction between burnout and depressive symptoms, particularly in predicting future ACMCSA. Early intervention targeting exhaustion and burnout may mitigate symptom development and reduce the risk of ACMCSA.

Objectives
Factors associated with multimorbidity, polypharmacy and Medication Regimen Complexity Index (MRCI) may vary across countries. However, such data are lacking in the present study setting. This study aimed to identify factors associated with multimorbidity, polypharmacy and MRCI among adults living with hypertension in public hospitals of South Gondar Zone.

Design
Multicentred cross-sectional design

Setting
Public hospitals of Comprehensive Specialised and Primary Hospitals, Ethiopia.

Participants
Adults living with hypertension who had follow-up visits at outpatient clinics and were selected by systematic random sampling from 1 December 2021 to 28 February 2022.

Primary and secondary outcome measures
Medication regimen complexity was assessed using a 65-item medication regimen complexity tool. Sociodemographic data were collected through an interview, while polypharmacy and clinical characteristics were documented using a checklist. Data were entered into SPSS V.26 and analysed using STATA V.17. A binary logistic regression model was used to determine the AOR of factors associated with multimorbidity and polypharmacy. For factors influencing MRCI, an ordinal logistic regression was used.

Results
We found participants from Nefas Mewucha Hospital (AOR = 0.3, 95% CI 0.15 to 0.59) and Mekane Eyesus Hospital (AOR = 0.17, 95% CI 0.07 to 0.38), compared with Debre Tabor Comprehensive Specialised Hospital, polypharmacy (AOR = 5.52, 95% CI 1.49 to 20.39), medium (AOR = 19.76, 95% CI 5.86 to 66.56) and high MRCI (AOR = 120.32, 95% CI 33.12 to 437.07) were associated with multimorbidity. Multimorbidity (AOR = 25.4, 95% CI 7.48 to 86.23), controlled blood pressure (AOR = 0.43, 95% CI 0.19 to 0.92) and duration of hypertension therapy 5 years or more (AOR = 2.12, 95% CI 1.08 to 4.16) were associated with polypharmacy. Whereas controlled BP (AOR = 0.48, 95% CI 0.32 to 0.72) and multimorbidity (AOR = 14.55, 95% CI 9.00 to 23.52) were significantly associated with high MRCI. The prevalence of multimorbidity, high MRCI and polypharmacy was found in 46.1%, 35.22% and 12.29% of participants, respectively.

Conclusion
A considerable proportion of participants with hypertension experienced multimorbidity, polypharmacy and high medication complexity. Polypharmacy, primary hospital setting and high MRCI were independent variables associated with multimorbidity. On the other hand, multimorbidity and controlled BP were associated with polypharmacy and MRCI. Hypertension care should consider multimorbidity, polypharmacy and medication complexity.

Objectives
Women and men/partners who experience miscarriage often report poor care experiences within health services around the time of miscarriage and beyond; less is known about recurrent miscarriage (RM) care. Research is needed to explore the potential targets for improvement, in addition to identifying factors that support or hinder service improvement efforts and the implementation and/or sustainment of desired models of RM care. This study aimed to explore the views of knowledge users regarding RM services and supports; specifically: (a) practices and experiences and (b) facilitators and barriers to providing desired services and supports.

Study design
We adopted a qualitative study design underpinned by constructivism, incorporating semistructured interviews. Data were analysed using reflexive thematic analysis.

Setting
Participants were recruited across the Republic of Ireland, incorporating perspectives from different geographical areas, hospital types and RM services.

Participants
We interviewed 13 women and 7 men/partners who had experienced ≥2 consecutive miscarriages, and 42 people involved in the delivery and/or management of RM services and supports, between June 2020 and February 2021.

Results
We generated three themes from the data: (1) dedicated staff; (2) dedicated space and time and (3) dedicated funding and support—prioritise RM. Our analysis supports the need for a standardised, dedicated and adequately resourced and supported service. One in which people experiencing RM are offered appropriate, individualised, timely and accessible care and support—beginning following the first miscarriage, and following a graded model. Implementation requires several multilevel actions, including prioritising RM care, adequately funding and resourcing services, enhancing health professional education and support, care coordination within and between hospitals and primary care and improving public awareness of, and addressing stigma surrounding, miscarriage.

Conclusions
Our analysis provides context to ‘good’ and ‘poor’ care experiences and identifies what facilitators and barriers exist to affecting change in RM care within healthcare and broader systems. In light of recent debates regarding how best to deliver RM care, and changing international guidelines, this work provides timely and important knowledge that should be harnessed to inform service improvement efforts in the Republic of Ireland and beyond.

Objectives
Following a stroke, people often receive informal care from friends and family. Some carers adopt the role quickly, whereas others find it more difficult to see themselves as a ‘carer’ and do not access relevant support. To understand the process of how and when informal carers start to see themselves as such, and their preferred terminology and experiences of support in this role.

Design
The study adopted an exploratory qualitative design, collecting data through semistructured interviews with participants and a brief survey of participant demographics. Data were analysed thematically using a template analysis approach. Patient, carer and public involvement collaboration, through a formed carer advisory group, enhanced the study methodology.

Setting
The project was a nationwide study, with participants residing across the UK. The study took place from September 2021 to April 2024.

Participants
18 adults (aged 18 years and above) who had provided care or support to a friend or family member after a stroke that occurred at least 1 year prior to participation completed the study.

Results
Five main themes were developed: (1) adopting and adjusting to the care role, (2) accessibility of support, (3) perceptions of support, (4) acceptability of care-related language and terminology and (5) function of care-related language and terminology. Facilitators and barriers to participants self-identifying with the care role were identified. Self-identification was found to commonly occur at four key points along the stroke trajectory: instant recognition at the time of the stroke event; at the point of planning discharge from hospital; on initial return home from hospital; and at a later stage in the caregiving experience. Two main contrasting opinions around the acceptability of care-related terminology were shared: a favourable view of care-related language and a depreciative view. Accessibility of support services and suggestions for future support provision were discussed.

Conclusions
Individuals identify as ‘carers’ at different points and to different extents throughout the stroke trajectory. Findings outline the factors that facilitate this self-identification process and those which constitute challenges to adjusting to the role. Recommendations are made relating to the accessibility of support for informal carers of stroke survivors, including: use of more accessible and inclusive care-related language, educational needs relating to what a ‘carer’ is and involvement of carers and wider family in the rehabilitation process.

Objective
Falling is common among older adults in residential aged care facilities (RACFs) and potential inappropriate psychotropic medicines (PIPMs) use may increase the risk of falling. This study aimed to determine the impact of PIPMs on falls using longitudinal observational data.

Methods
A retrospective longitudinal cohort study was conducted using routinely collected electronic health data from 23 RACFs in Sydney, New South Wales, Australia. The study included 3064 permanent residents aged ≥65 (2020–2021). PIPMs were identified using updated Beers criteria 2023. We considered three fall outcome groups: all falls, injurious falls and falls requiring hospitalisation. The falls incidence rates (IRs) were calculated for overall residents in RACFs as well as for central nervous system (CNS)-PIPM users and non-users. We applied a zero-inflated negative binomial regression model to assess the association between falls and CNS-PIPMs.

Results
A total of 40% (n=1224) of long-term care residents used at least one CNS-PIPM and 10% of residents (n=302) used two or more. The falls IRs of CNS-PIPM users were 16.2 falls per 1000 resident days (95% CI 15.9 to 16.5) for all falls, 5.68 falls per 1000 resident days (95% CI 5.48 to 5.88) for injurious falls and 1.77 falls per 1000 resident days (95% CI 1.66 to 1.88) for falls requiring hospitalisation, whereas the falls IRs of non-CNS-PIPM users were 10.8 falls per 1000 resident days (95% CI 10.6 to 11.0) for all falls, 3.65 falls per 1000 resident days (95% CI 3.52 to 3.78) for injurious falls and 1.26 falls per 1000 resident days (95% CI 1.19 to 1.33) for falls requiring hospitalisation. CNS-PIPM users had a significantly greater rate of falls overall compared with non-users (IRR 1.29; 95% CI 1.16 to 1.44) for all outcomes.

Conclusions
Falls are frequent among CNS-PIPM users resulting in injury and hospitalisation, with 70% of CNS-PIPM users falling at least once and one in three requiring admissions to hospital. Reviewing residents’ use of psychotropic medicines should be considered as part of strategies to reduce falls incidence among older adults in RACFs.

Objective
To examine the association between clinical severity features, laboratory biomarkers and adverse maternal outcomes in women diagnosed with pre-eclampsia–eclampsia syndrome.

Design
A retrospective cohort study design.

Setting
Ayder Comprehensive Specialized Hospital, a tertiary care hospital in Tigray, Ethiopia.

Participants
A total of 1095 women diagnosed with pre-eclampsia–eclampsia syndrome between 2015 and 2021 were consecutively included.

Outcomes
Adverse maternal outcomes, defined as a composite of intensive care unit (ICU) admission, need for haemodialysis, pulmonary oedema or death.

Methods
A multivariable binary logistic regression model was used to assess the association between pre-eclampsia severity features, laboratory biomarkers and adverse maternal outcomes. Adjusted odds ratios (AORs) were estimated with 95% CIs.

Results
Adverse maternal outcomes occurred in 100 (9.1%) of cases. Eclampsia (AOR=8.85, 95% CI 4.08 to 19.20), lower extremity oedema (AOR=2.28, 95% CI 1.06 to 4.90) and elevated creatinine levels (AOR=5.07, 95% CI 2.21 to 11.61) were significant predictors. Additionally, increasing maternal age was associated with a higher risk (AOR=1.07, 95% CI 1.00 to 1.13).

Conclusions
Clinical severity features (eclampsia and lower extremity oedema), laboratory biomarkers (elevated creatinine) and increasing maternal age were associated with unfavourable maternal outcomes. These findings highlight the importance of integrating clinical signs and laboratory biomarkers into risk assessment for pre-eclampsia patients.

Objectives
Ineffective erythropoiesis, although at a mild degree, could make individuals with beta thalassaemia trait (BTT) vulnerable to folate deficiency. This could be more pronounced in communities where dietary intake of folate is substantially lower. We aimed to assess serum folate levels and dietary folate consumption in individuals with BTT and compare them with healthy matched controls.

Design
A case–control study.

Setting
This study was conducted between June 2021 and June 2022 at a regional thalassaemia centre in Sri Lanka.

Participants
The study includes 100 sets of samples, including a BTT and an age-matched, sex-matched and body mass index-matched healthy individual from the same household in each set, aged between 6 and 25 years.

Primary and secondary outcome measures
The primary outcomes were serum folate levels and the daily dietary intake of folate in BTTs and controls. Serum folate levels were determined using a fully automated Cobas immunoassay analyser. The dietary folate intake was determined by recording 24-hour dietary recall recorded over 3 consecutive days, with the average intake calculated.

Results
The results suggested that 34% of cases and 24% of controls had serum folate deficiency (

Objective
The purpose of this study was to determine how strongly mean systolic blood pressure (mSBP, mm Hg) was related to hypertension control and if an mSBP

This study uses 2021 data on the percentage of unavailable opioid tests in the US to examine how opioid involvement informs injury death investigations.

Objective
Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes, which can lead to foot deformity, ulceration, and even amputation. Early identification is crucial, as more than half of DPN patients are asymptomatic in the early stage. This study aimed to develop and validate multiple risk prediction models for DPN in patients with type 2 diabetes mellitus (T2DM) and to apply the Shapley Additive Explanation (SHAP) method to interpret the best-performing model and identify key risk factors for DPN.

Design
A single-centre retrospective cohort study.

Setting
The study was conducted at a tertiary teaching hospital in Hainan.

Participants and methods
Data were retrospectively collected from the electronic medical records of patients with diabetes admitted between 1 January 2021 and 28 March 2023. After data preprocessing, 73 variables were retained for baseline analysis. Feature selection was performed using univariate analysis combined with recursive feature elimination (RFE). The dataset was split into training and test sets in an 8:2 ratio, with the training set balanced via the Synthetic Minority Over-sampling Technique. Six machine learning algorithms were applied to develop prediction models for DPN. Hyperparameters were optimised using grid search with 10-fold cross-validation. Model performance was assessed using various metrics on the test set, and the SHAP method was used to interpret the best-performing model.

Results
The study included 3343 T2DM inpatients, with a median age of 60 years (IQR 53–69), and 88.6% (2962/3343) had DPN. The RFE method identified 12 key factors for model construction. Among the six models, XGBoost showed the best predictive performance, achieving an area under the curve of 0.960, accuracy of 0.927, precision of 0.969, recall of 0.948, F1-score of 0.958 and a G-mean of 0.850 on the test set. The SHAP analysis highlighted C reactive protein, total bile acids, gamma-glutamyl transpeptidase, age and lipoprotein(a) as the top five predictors of DPN.

Conclusions
The machine learning approach successfully established a DPN risk prediction model with excellent performance. The use of the interpretable SHAP method could enhance the model’s clinical applicability.

Stroke, Ahead of Print. BACKGROUND:The efficacy of minimally invasive surgery (MIS) in improving outcomes after nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with inconsistent findings from randomized clinical trials. Our objective was to evaluate the real-world impact of MIS on ICH outcomes using a nationally representative cohort.METHODS:We performed a retrospective cohort study of patients with a nontraumatic ICH enrolled in the American Heart Association Get With The Guidelines-Stroke Registry between January 1, 2011, and December 31, 2021. We excluded patients with a diagnosis of ischemic stroke or other intracranial hemorrhage subtypes, those who underwent open craniotomy or craniectomy, and patients transferred to another hospital. The exposure was MIS, defined as a composite of stereotactic surgical evacuation and endoscopic surgical evacuation. The primary outcome was in-hospital mortality, while secondary outcomes included functional outcomes at discharge (discharge disposition, ambulatory status, and modified Rankin Scale score). We matched patients who underwent MIS with nonsurgical patients using overlap propensity matching and used multiple logistic regression to study the association between MIS and outcomes.RESULTS:Among 684 467 patients with ICH, 555 964 were included; the mean age was 68 (SD, 15.3) years, and 262 999 (47.3%) were female. MIS was performed in 703 patients of whom 312 had stereotactic surgery and 391 had endoscopic surgery. In the matched cohort, in-hospital deaths occurred in 60 of 446 (13.5%) with MIS and 8321 of 35 361 patients (23.5%) without surgery. In regression analyses, MIS was associated with lower in-hospital mortality (adjusted odds ratio, 0.50 [95% CI, 0.39–0.65]) and favorable discharge disposition (adjusted odds ratio, 1.93 [95% CI, 1.61–2.32]) but not with ambulatory status or functional outcomes. In additional analyses, stereotactic surgery and endoscopic surgery were independently associated with lower mortality.CONCLUSIONS:In a large diverse cohort of patients with ICH, MIS was associated with lower in-hospital mortality and favorable discharge disposition. These findings support efforts to understand the durable impact of MIS in patients with ICH.

Stroke, Ahead of Print. BACKGROUND:Recent randomized control trials have demonstrated the efficacy and safety of middle meningeal artery embolization (MMAE) as an adjunct to conventional management for patients with nonacute subdural hematoma (SDH); however, a large majority of trial participants received surgical evacuation as part of the standard of care. Thus, the efficacy and safety of standalone MMAE compared with conservative management (CM) for patients with nonsurgical SDH are unclear.METHODS:This was a retrospective cohort study of the 2019 to 2021 Nationwide Readmissions Database in the United States. Patients with nonsurgical nontraumatic SDH were identified, and MMAE patients were matched with similar CM patients using propensity score matching calculated from demographics, comorbidities, and initial hospitalization outcomes. Patients were followed up to 300 days. The primary end point was composite surgical rescue or death, and secondary end points included surgical rescue and all-cause mortality by 180 days.RESULTS:24 465 patients with nonsurgical nontraumatic SDH were identified; 2228 (9.1%) underwent MMAE. After propensity score matching, 6675 patients remained in the CM group and 2217 in the MMAE group. At 180 days, MMAE patients had a significantly lower risk of surgery or death compared with CM (8.2% versus 10.9%; relative risk, 0.75 [95% CI, 0.59–0.96];P=0.022) and lower risk of death (1.1% versus 3.0%; relative risk, 0.38 [95% CI, 0.17–0.86];P=0.020). Rates of surgical rescue among MMAE and CM patients at 180 days were similar (7.1% versus 8.4%; relative risk, 0.85 [95% CI, 0.63–1.14];P=0.27). Time-to-event analyses for the entire 300-day study follow-up period confirmed that while MMAE was associated with a lower cumulative risk of all-cause mortality (hazard ratio, 0.55 [95% CI, 0.35–0.87];P=0.010), it was not associated with a different risk of surgical rescue (hazard ratio, 1.00 [95% CI, 0.76–1.31];P=1.00).CONCLUSIONS:Standalone MMAE may be beneficial for patients with nonsurgical nontraumatic SDH by reducing the long-term risk of all-cause mortality.

Stroke, Ahead of Print. BACKGROUND:Nonverbal cognitive deficits in poststroke aphasia remain poorly understood. They may result from direct stroke damage or disconnections of preserved cortical regions due to white matter injury, which may be worsened by white matter hyperintensities (WMH). Here, we examined the prevalence of nonverbal cognitive deficits in chronic poststroke aphasia and whether WMH-related disconnections contribute to these deficits beyond those caused by stroke lesions.METHODS:Individuals with chronic left hemisphere ischemic or hemorrhagic stroke were enrolled between 2012 and 2021. Nonverbal cognition was assessed using the Matrix Subtest of the Wechsler Adult Intelligence Scale Version IV, the Pyramids and Palm Trees Test, and the Kissing and Dancing Test. Stroke lesions and WMH masks were derived from structural magnetic resonance imaging scans. Disconnection severity from stroke lesions and WMH was quantified across association, commissural, and projection fibers using the Lesion Quantification Toolbox. Hierarchical regression models examined whether WMH-related disconnections explained additional variance in nonverbal cognitive deficits.RESULTS:Among 73 participants (mean age, 59.1±11.9 years; 61.6% male; mean time poststroke, 47.3±52.4 months), nonverbal cognitive deficits were common (Wechsler Adult Intelligence Scale, 27/58 [46.6%]; Pyramids and Palm Trees Test, 44/73 [60.3%]; Kissing and Dancing Test, 32/61 [52.5%]). Lesion-related commissural disconnections were associated with worse Kissing and Dancing Test performance (r[61]=−0.378;P=0.004), whereas WMH-related disconnections across all fiber types were linked to lower Pyramids and Palm Trees Test scores (r[73]=−0.392 to −0.462;P