The family function has long been stated to determine the health of each members in the family and the physicians effort understanding the family function in depths will provide detailed information upon not only dealing with the patient but also provide better doctor patient relationship.
In order to understand how family function affects medical utilization and to analyze the descriptive characteristics of the variables which influence family functioning and the medical utilization a study was performed in an Oryu health service Clinic from March 1987 to October 1987.
Total 204 patients were asked to complete Family APGAR designed by Smikstein(1978) within first 2 months. A chart review was then conducted 6 months after their visit and following results were obtained.
Except for the 13 patients who dropped out during the study period 161 patients were female and 30 patients were male. Their sociodemographic characteristics revealed low economic class, poorly educated, and had high risk of family dysfunction. Their mean age was 55.2 years old.
According to family APGAR they had moderate dysfunctional family function with average score of 5.26.
Family APGAR was significantly affected by age, religion, level of education, and number of generations living together. Also the chronicity of the problems patient complained were one of important factors the influence family APGAR score.
The mean number of visits was 5.7 visits per 6 months and it was notable that the higher the family APGAR score the less visit was performed. Other important factors that affect the medical utilization was the chronicity of illness.
The incidence of family dysfuction diagnosed by the residents was 12.4% similar to that of Mengel(1987).
The diagnostic accuacy of family APGAR is doughtful as it's false positive rates are fairly high but it is a good utilitarian tool in screening family function in a short time. However, the family physicians should not rely upon family APGAR alone but to emphasis on the assesment of family function and should spend more effort under standing family function in detail and further studies on extrafamiliar factors should be performed in the future.

Hypertensive emergencies are situations in which greatly elevated blood pressure must be lowered within 1 hour to reduce actual patient risk, whereas urgencies are situations where severe elevations in blood pressure are not causing immediate end-organ damage but should be controlled within 24 hours to reduce potential patient risk. In this report the efficacy and safety of sublingual nifedipine were evaluated in 36 patients, 14 men and 22 women, aged 27 to 76 years who had acute severe hypertension. Before treatment mean systolic blood pressure(SBP) was 204.7±28.5 mmHg, mean diastolic blood pressure(DBP) was 121.7±16.5mmHg, average mean arterial blood pressure(MBP) was 148.4±19.1mmHg, and mean pulse rate(PR) was 75.3±18.3 beats/minute. AT 30 minutes after administration of 10mg of sublingual nifedipine, the decreases in the SBP, DBP, and MBP for the group were 48.1±25.4mmHg, 23.6±18.2mmHg, 32.6±18.0mmHg respectively, all of which were highly significant(P<0.01). The another group of patients who were 9 men and 17 women, aged 37 to 74 years, and also had acute severe hypertension were treated with hydralazine to compare with the efficacy and safety of nifedipine. Before treatment SBP, DBP, MBP, and PR were 205.4±25.3 mmHg, 124.8±19.1 mmHg, 152.3±18.7 mmHg, and 76.0±12.7 beats/minute respectively. This two groups of patients had no significant differences in the demographic characteristics and clinical data. At 30 minutes after administration of 10 mg of hydralazine parenterally, the decreases in SBP, DBP, and MBP for the group were 32.3±22.7 mmHg, 21.5±18.7 mmHg, 24.1±19.3 mmHg, respectively, all of which were highly significant(P<0.01). With the comparison of fall in blood pressure between hydralazine treated group and nifedipine treated group, 10 mg of nifedipine produced a significantly greater angihypertensive effect than 10 mg of hydralazine(48.1±25.4 mmHg vs. 32.3±22.7 mmHg SBP, P<0.01, 23.6±18.2 mmHg vs. 21.5±18.7 mmHg DBP, P<0.05, 32.6±18.0 mmHg, 24.1±19.3 mmHg MBP, P<0.01). The response to nifedipine correlated with the blood pressure value prior to treatment, but did not correlated with age, gender or the type of hypertensive emergency and urgency. The side effects noted after use of nifedipine were headache in 3 patients, dizziness in 1 patient.
These results syggest that sublingual nifedipine is a safe, effective, and practical agent for treating patients with acute severs hypertension, and may be used in an OPD setting as a first-line drug.