While providing home care for a family member with senile dementia is clearly extremely stressful, there has been little controlled research assessing the specific effects of this stress on caregiver psychological, social, and health functioning. To address this question, 44 primary caregivers of senile dementia patients and 44 matched controls completed a series of questionnaires and interview assessments. Caregivers reported significantly higher levels of depression and negative affect toward their relatives, and lower overall life satisfaction than controls. Caregivers also had significant impairment of their social activities, including visits with friends, vacations, and church attendance when compared with controls. Caregivers expressed less satisfaction with their social networks than did controls, but the groups did not differ in objective size of social network or number of network contacts. Caregivers reported poorer health, more prescription medication use, and higher utilization of health care than controls. Results clearly indicate the serious and wide-ranging effects of the stress of caregiving, and reinforce the importance of providing comprehensive services for caregiving families.

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The relationship of arthritis and sexual dysfunction was investigated among 169 patients with rheumatoid arthritis, osteoarthritis and spondyloarthropathy, 130 of whom were pair-matched to controls. Assessments of marital happiness and depressed mood were also made using the CES-D and the Azrin Marital Happiness Scale (AMHS). Sexual dysfunctions were found to be common among patients and controls, the majority in both groups reporting one or more dysfunctions. Impotence was more common among male patients than controls and was found to be associated with co-morbidity and the taking of methotrexate. Depressed mood was more common among patients and was associated with certain sexual difficulties, but not with impotence. Marital unhappiness, as indicated by AMHS scores, was not associated with arthritis but was associated with sexual dysfunction, sexual dissatisfaction and being female.

A survey of 200 rheumatoid arthritis (RA) patients was conducted to identify the kinds and frequencies of intentional and unintentional reasons for missed medication doses. Planned and unplanned changes in usual activity routines accounted for most of the unintentionally missed doses, while side effects attributed to the medication accounted for most of the intentionally missed doses. Patients who did not miss medication doses were different from those who did by tending to have more financial resources and social support available to them.

A quasi-experiment was conducted on 127 hospitalized rheumatoid arthritis patients to determine the relative success of 3 patient teaching strategies-an indiviidualized program, a routinized program, and a no-planned-instruction program-on patients' knowledge of their disease and treatment. Data analysis revealed that the individualized program produced a 100% greater learning gain than the routinized program in patients who had low pretest scores. The results suggest that maximum patient learning occurs when the teaching process accommodates important patient differences.An important question in arthritis patient education is how to establish the appropriate use of a variety of instructional methods and materials, in order to maximize patients' learning about their treatment and disease under conditions of limited time (1). The 2 poles of the instructional continuum are: teaching each patient the same thing in the same way (the routinization strategy) and teaching patients different things in different ways (the individualization strategy). While numerous patient education studies on arthritis and other chronic diseases have resulted in various degrees of success in teaching patients about their disease and treatment with the use of different kinds of routinized procedures, e.g., classes, discussion groups, and reading materials (2-lo), there have been no reports of studies in which an individualized strategy is compared with a routinized strategy.Using a diagnostic/prescriptive decisionmaking process, the individualization strategy entails the use of instructional materials, methods, and content that are selected on the basis of one or more educationally relevant psychosocial and physical characteristics of the patient. Thus, patients' instructional programs may vary on the basis of instructional time, instructional objectives, or instructional methods and materials.Green et a1 (1 1) and Bartlett (12) have elaborated individualized patient education models. However, in the area of cognitive program objectives, these models are not well developed since they do not specify a set of decision rules that permit selection of appropriate instructional materials, methods, and objectives given multiple psychosocial and physical characteristics of patients. The set of explicit decision rules is what differentiates the individualization strategy from studies that have used one-to-one or individual patient teaching (13-15). One-to-one teaching is individualized if the educator has selected materials, methods, and/or objectives on the basis of the special characteristics of the patient.Learning style research is relevant for understanding the importance of the individualization strategy. Two broad approaches have been taken. The first involves research on cognitive learning styles (16) in which the concern is with the way cognitive characteristics affect information processing, e.g., field dependence-independence (171, conceptual level (18),

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