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Background: Fasting levels of glucagon are known to be elevated in youth and adults with type 2 diabetes mellitus (T2D). Children and adolescents with obesity were previously reported to show increasing fasting and post-glucose-challenge hyperglucagonemia across the spectrum of glucose tolerance, while no data are available in those with impaired fasting glucose (IFG). Materials and methods: Individuals from the Beta-JUDO study population (Uppsala and Salzburg 2010-2016) (n=101, age 13.3 ± 2.8, m/f=50/51) were included (90 with overweight or obesity, 11 with normal weight). Standardized OGTT were performed and plasma glucose, glucagon and insulin concentrations assessed at baseline, 5, 10, 15, 30, 60, 90 and 120 minutes. Patients were grouped according to their glycemic state in six groups with normal glucose metabolism (NGM) and normal weight (NG-NW), NGM with obesity or overweight (NG-O), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), IGT+IFG and T2D, and in two groups with NGM and impaired glucose metabolism (IGM), for statistical analysis. Results and conclusion: Glucagon concentrations were elevated in young normoglycemic individuals with overweight or obesity (NG-O) compared to normoglycemic individuals with normal weight. Glucagon levels, fasting and dynamic, increased with progressing glycemic deterioration, except in IFG, where levels were comparable to those in NG-O. All glycemic groups showed an overall suppression of glucagon during OGTT. An initial increase of glucagon could be observed in T2D. In T2D, glucagon showed a strong direct linear correlation with plasma glucose levels during OGTT. Glucagon in adolescents, as in adults, may play a role in the disease progression of T2D. [ABSTRACT FROM AUTHOR]

The article focuses on the roles and responsibilities of nursing assistant professions in Austria, specifically detailing the tasks delegated to them within the healthcare framework. Topics include the scope of nursing assistant professions, encompassing activities in the nursing process such as assessment, observation, and execution of nursing measures. It also covers their involvement in medical diagnostics and therapy under delegation.

The article deals with the tension between the duty of confidentiality of medical institutions and practitioners on one hand, and the right to information of the legal guardians on the other hand, in the treatment of minors. It is pointed out that the duty of confidentiality towards legal representatives of incapacitated minors may be breached and must be breached due to obligations to provide information. Capable minors have the right to keep sensitive information confidential, while legal guardians have the right to determine the whereabouts of minors, unless this contradicts the best interests of the child. Practitioners must inform the legal guardians of the whereabouts of minors and breach their duty of confidentiality in this case. [Extracted from the article]

The article presents the discussion on modification aims to address physician shortages and ensure uninterrupted blood supply. Topics include authorized to assess the health suitability of blood donors, grant approval for whole blood donation, and perform blood collection in mobile blood donation facilities without the presence of a physician; and standardized health assessment questionnaires, and the availability of direct consultation with a physician.

The Journal for Medical and Health Law (JMG) presents interesting articles on the topic of health and medical law in its second issue of the year. One focus is on the decision of the Supreme Court regarding "wrongful birth" and "wrongful conception". Other articles address topics such as the recognition of foreign degrees in the healthcare sector, the recruitment of nursing staff from third countries, and the assumption of costs by the Austrian Integration Fund. In addition, the journal offers contributions on various legal aspects in the medical field. One article deals with the health function of forests. [Extracted from the article]

Background: Nonalcoholic fatty liver disease (NAFLD) is the leading hepatic disease in children, ranging from steatosis to steatohepatitis and fibrosis. Age, sex, hormonal levels, pubertal stages, genetic risk- and epigenetic factors are among the many influencing factors. Appearing predominantly in children with obesity, but not exclusively, it is the liver's manifestation of the metabolic syndrome but can also exist as an isolated entity. Summary: Pediatric NAFLD differs from the adult phenotype. This narrative review on NAFLD in children with obesity provides an overview of the current knowledge on risk factors, screening, and diagnostic methods, as well state-of-the-art treatment. The recent discussion on the proposition of a new nomenclature – Metabolic [Dysfunction-] Associated Liver Disease – is featured, and current gaps of knowledge are discussed. Key Messages: Currently, there is no international consensus on screening and monitoring of pediatric NAFLD. With lifestyle interventions being the cornerstone of treatment, no registered pharmacological treatment for pediatric NAFLD is available. Development and validation of additional noninvasive biomarkers, scores and imaging tools suitable to subcategorize, screen and monitor pediatric patients are necessary. With a variety of upcoming and promising agents, clear recommendations for pediatric nonalcoholic steatohepatitis trials are urgently needed. [ABSTRACT FROM AUTHOR]

In the editorial of the Journal for Medical and Health Law (JMG), reference is made to the upcoming regional, national, and European elections, which also have implications for the healthcare system. It is mentioned that the Austrian healthcare reform still requires many steps. Two articles in this issue address changes in pharmacy law and the benefits of the new electronic parent-child pass. Another article deals with the Supreme Court's case law on claims for damages in cases of unintended pregnancy despite the use of a spiral contraceptive. It also highlights the legal entitlement to an advance healthcare directive and other less dramatic topics in health law. [Extracted from the article]

The article presents the discussion on competence of physician assistants (PA) and nursing assistants (PFA) to perform peripheral venous catheter flushing. Topics include eliminate the competence for maintaining the patency of peripheral venous catheters and hinder the proper execution of connecting and disconnecting ongoing infusions by PAs and PFAs; and performing the connection and disconnection of ongoing infusions in accordance with professional standards.

The editorial of the Journal for Medical and Health Law (JMG) refers to various crises in the year 2023, including the Corona pandemic, Russia's attack on Ukraine, and the climate crisis. It also addresses the "personnel crisis" in the healthcare sector and discusses solutions such as the implementation of nursing education. Other topics of the editorial include decision-making capacity in mental illnesses, professional legal issues of first responders and medical disciplinary law, liability of medical device manufacturers and authorities, as well as the temporary employment directive in outsourced hospitals. Recommendations are also given for ethically responsible medical practice in the use of artificial intelligence and the efficiency of the Austrian healthcare system compared internationally. The editorial also includes glosses on various court decisions regarding topics such as the discriminatory exclusion from participating in an entrance examination for military doctors, the social security number as health data, the requirements for medical expert opinions, the limits of freedom of speech in relation to a doctor's statement, as well as loss of earnings under the Crime Victims Compensation Act and the right to a decision within reasonable time limits in proceedings for granting a pharmacy concession. The editorial concludes with Christmas and New Year's greetings from the editorial board. [Extracted from the article]

Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviors (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED− vs. SED+ and MVPA+ vs. MVPA− had lower MetS (p < 0.01 and p < 0.001) and MetScore (p < 0.001). SED−/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED−/MVPA− vs. SED+/MVPA+ (p < 0.001), MetScore was lower in SED−/MVPA− independently of body mass index (BMI) (p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis (p < 0.05). Both MVPA (p < 0.01) and SED times (p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Background: Elastofibroma dorsi is a benign soft tissue lesion composed of abnormal elastic fibers. Degenerated elastic fibers in skin and liver are associated with clusterin, an apoprotein that shares functional properties with small heat shock proteins. We evaluated the staining pattern and possible role of clusterin in elastofibroma dorsi., Material and Methods: Twenty-one subcutaneous elastofibromas from the scapular region were evaluated with Elastica van Gieson and Orcein stains, immunohistochemically with antibodies to clusterin, smooth muscle actin, S-100, vimentin and CD34 and correlated with clinical data with respect to physical trauma., Results: Clusterin correlated with the staining pattern of Elastica van Gieson and labelled abnormal broad coarse fibrillar and globular elastic fibers in all elastofibromas. Orcein stains additionally identified fine oxytalan fibers which were not stained by clusterin. Clusterin staining was observed only on the outside of the elastin fibers, while the cores of fibers and globules were unstained. 4/21 elastofibromas showed cellular nodules with a myxoid/collagenous stroma. The round to oval cells showed cytoplasmic staining with vimentin and clusterin; CD34 labelled mostly cell membranes. The cells lacked SMA and S-100 expression. The central areas of the nodules were devoid of elastic fibers, but the periphery contained coarse fibers and globules. 9/ 11 patients, for whom clinical data were available, reported trauma to the scapular region., Conclusion: Many investigated ED were associated with trauma, which supports a reactive/degenerative etiology of ED. The abnormal large elastic fibers in all ED were enveloped by clusterin. Clusterin deposition may protect elastic fibers from degradation and thus contribute indirectly to the tumor-like presentation of ED.