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Item Case Presentation: Shoulder pain as a rheumatic manifestation of diabetes mellitus(Association of Kenya Physicians, 2007) Okanga, J. B.; Yossa, G. P.; Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)Shoulder pain, a common musculoskeletal symptom, aetiologically is related to periarticular lesions mainly subacronial impingment (SAI) (90% adults). Articular lesions e.g. Synovvitis adhesive capsulitis (frozen shoulder) etc may be referred to the neck and humeral deltoid insertion. Referred pain from the cervical or thoracic spine, thoracic outlet or subdiaphramatic structures may manifest at the shoulder. Diabetes mellitus syndrome may be complicated by adhesive capsulitis more frequently than in the general population. A case is presented of a 52yr old house wife of high social standing, who has been followed up for 5yrs. Initially left shoulder pain but in the last 2yrs predominantly right shoulder pain, less involvement of the neck, right wrist and right foot. She has been under several clinicians with a frustration long list of probable diagnoses to her ailment. Diabetes mellitus was diagnosed in September 2005 and attacks related to hyperglycaemia/metabolic decompensation. The last attack was in January 2007 which necessitated hospitalization. A visiting rheumatologist confirmed "FROZEN SHOULDER" with diabetes mellitus. A multidisciplinary and multifactorial intervention aimed at multiple risk factors of diabetes syndrome is the way forward. Patient education/nutrition counseling and physiotherapy is the cornerstone of effective management.Item Management of Arthritis(Association of Kenya Physicians, 2007) Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)Item Pilot study of reproductive health counseling in a pediatric rheumatology clinic(Wiley, 2014-04) Ronis, Tova; Frankovich, Jennifer; Yen, Sophia; Sandborg, Christy; Chira, Peter; Department of Pediatrics, Indiana University School of MedicineObjective: To assess perception and behavior after reproductive health counseling among adolescent patients in a tertiary care-based pediatric rheumatology clinic. Methods: Adolescent females seen at Stanford pediatric rheumatology clinic were prospectively enrolled during routine visits. At study start, standard clinic procedures for the following were reviewed with providers: 1) HEADSS (home, education, activities, drugs, sexual activity, and suicide/depression) assessment; 2) reproductive health counseling; and 3) medical record documentation. Patients were enrolled if providers indicated that they performed HEADSS assessment and reproductive health counseling. At enrollment, patients completed a survey to assess perceptions of reproductive health counseling. Chart review confirmed documented discussions. Follow-up survey 3-5 months after enrollment tracked reproductive health information seeking behavior. Results: Ninety females (ages 17 ± 2 years old) participated. Almost all patients (99%) agreed that reproductive health was discussed. Seventy-one percent reported that pregnancy risks were discussed, 42% had recent concerns about reproductive health, and 33% reported their provider recommended that they seek further reproductive health care. Eighty-four patients completed follow-up phone surveys, with 25% reporting seeking further information on reproductive health concerns but merely 9.5% actually sought further care. Only 18% reported having ever asked their rheumatology provider for guidance regarding reproductive health care concerns. Conclusion: Routine reproductive health discussion and counseling are necessary in a rheumatology clinic; as in our experience, a substantial number of adolescents have concerns and actively seek reproductive health information. Despite these discussions, teens rarely pursued further reproductive health care. Further work to bridge this gap is needed.