Alpha-Fetoprotein levels in normal males from seven ethnic groups with different hepatocellular carcinoma risks

Alpha-Fetoprotein (AFP) levels of 1,335 males (15 years and older) of seven ethnic groups (Chinese, Indians, and Malays from Singapore, Caucasians from Lyon, and Blacks from Nairobi, forest, and the savanna region of the Ivory Coast) were determined by radioimmunoassay. A few elevated levels (up to 30 nanounits/ml) were detected in some normal individuals, especially in the older age-groups. In addition, there was a systematic age-dependency of AFP levels particularly evident in the groups from Singapore-Lyon, in which there was a 50% AFP increase between the ages of 20 and 40. Comparison between Africans on the one hand and people from Singapore-Lyon on the other hand revealed highly significant differences (p less than 0.001), especially in the younger groups, whereas Chinese, Malays, and Indians from Singapore had very similar AFP pattern; this suggests an important role for environmental factors in the regulation of AFP levels. The age dependency of the presumed effect of environmental factors is in keeping with experimental data showing that young animals respond more vigorously to AFP-stimulating factors. Although the incidence of hepatocellular carcinoma (HCC) differs in the three Singapore groups (the highest in Chinese and the lowest in Indians), no relationship was observed in this study between mean AFP level and HCC incidence in Singapore.

An international study of health and general systems of financing health care

In a previous study the author explored the linear relationship between infant mortality and real gross domestic product per capita, the number of physicians per 10,000 persons, and the number of hospitals per 1,000 persons in 18 countries. That study is here expanded and updated to include the experience of 7 additional countries for a current total 25 countries. In addition, the present study extends the analysis to include several additional explanatory variables, and it includes data for 1965 so that the data set now covers 1955, 1960, and 1965. Following the methodology of the initial study, the relationship estimated between infant mortality and the several explanatory variables is used to calculate the level of infant mortality that one would expect to find in each country for each of the 3 years considered, given the values of the explanatory variables. The size and sign of the difference between the actual and expected levels is then used to approximate the effect of different general systems of providing and financing health care on overall health status, since infant mortality is an approximate index for the overall level of health. The results of the initial study are by and large confirmed. They show that the percentage of health services financed or directly controlled by governments, and information on the relative size of the health sector, are apparently not important determinants of levels of health. On the other hand, the proportion of health care resources devoted to the provision of nonpersonal public health care does appear to be a significant determinant and therefore the role of nonpersonal public health warrants further study.