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1.
MMWR Morb Mortal Wkly Rep ; 69(7): 189-192, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32078593

RESUMO

Raising the minimum legal sales age (MLSA) for tobacco products to 21 years (T21) is a strategy to help prevent and delay the initiation of tobacco product use (1). On December 20, 2019, Congress raised the federal MLSA for tobacco products from 18 to 21 years. Before enactment of the federal T21 law, localities, states, and territories were increasingly adopting their own T21 laws as part of a comprehensive approach to prevent youth initiation of tobacco products, particularly in response to recent increases in use of e-cigarettes among youths (2). Nearly all tobacco product use begins during adolescence, and minors have cited social sources such as older peers and siblings as a common source of access to tobacco products (1,3). State and territorial T21 laws vary widely and can include provisions that might not benefit the public's health, including penalties to youths for purchase, use, or possession of tobacco products; exemptions for military populations; phase-in periods; and preemption of local laws. To understand the landscape of U.S. state and territorial T21 laws before enactment of the federal law, CDC assessed state and territorial laws prohibiting sales of all tobacco products to persons aged <21 years. As of December 20, 2019, 19 states, the District of Columbia (DC), Guam, and Palau had enacted T21 laws, including 13 enacted in 2019. Compared with T21 laws enacted during 2013-2018, more laws enacted in 2019 have purchase, use, or possession penalties; military exemptions; phase-in periods of 1 year or more; and preemption of local laws related to tobacco product sales. T21 laws could help prevent and reduce youth tobacco product use when implemented as part of a comprehensive approach that includes evidence-based, population-based tobacco control strategies such as smoke-free laws and pricing strategies (1,4).


Assuntos
Comércio/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Humanos , Estados Unidos
4.
Lancet ; 394(10209): 1668-1684, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668410

RESUMO

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.


Assuntos
Monitoramento de Medicamentos/métodos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Psicotrópicos/efeitos adversos , Saúde Pública/legislação & jurisprudência , Adolescente , Adulto , Comércio/legislação & jurisprudência , Coleta de Dados , Controle de Medicamentos e Entorpecentes/métodos , Feminino , Humanos , /legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Motivação , Psicotrópicos/classificação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
5.
Global Health ; 15(Suppl 1): 78, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775767

RESUMO

BACKGROUND: Trade and investment agreements negotiated after the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways. RESULTS: An analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways. CONCLUSIONS: The analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.


Assuntos
Comércio/legislação & jurisprudência , Cooperação Internacional/legislação & jurisprudência , Investimentos em Saúde/legislação & jurisprudência , Preparações Farmacêuticas/economia , Política Pública , Canadá , Custos e Análise de Custo , Acesso aos Serviços de Saúde , Humanos , Propriedade Intelectual , México , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 68(39): 845-850, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581164

RESUMO

Use of marijuana at an early age can affect memory, school performance, attention, and learning; conclusions have been mixed regarding its impact on mental health conditions, including psychosis, depression, and anxiety (1-3). Medical marijuana has been legal in Washington since 1998, and in 2012, voters approved the retail sale of marijuana for recreational use to persons aged ≥21 years. The first retail stores opened for business in July 2014. As more states legalize marijuana use by adults aged ≥21 years, the effect of legalization on use by youths will be important to monitor. To guide planning of activities aimed at reducing marijuana use by youths and to inform ongoing policy development, Public Health-Seattle & King County assessed trends and characteristics of past 30-day marijuana use among King County, Washington, public school students in grades 6, 8, 10, and 12. This report used biennial data for 2004-2016 from the Washington State Healthy Youth Survey. Among grade 6 students there was a decreasing trend in self-reported past 30-day marijuana use from 2004 to 2016, while the percentage of grade 8 students who had used marijuana during the past 30 days did not change during that period. Among students in grades 10 and 12, self-reported past 30-day use of marijuana increased from 2004 to 2012, then declined from 2012 to 2016. In 2016, the percentage of students with past 30-day marijuana use in King County was 0.6% among grade 6, 4.1% among grade 8, 13.9% among grade 10, and 25.5% among grade 12 students. Among grade 10 students, 24.0% of past 30-day marijuana users also smoked cigarettes, compared with 1.3% of nonusers. From 2004 to 2016 the prevalence of perception of great risk of harm from regular marijuana use decreased across all grades. Continued surveillance using consistent measures is needed to monitor the impact of marijuana legalization and emerging public health issues, given variable legislation approaches among jurisdictions.


Assuntos
Uso da Maconha/epidemiologia , Uso da Maconha/tendências , Setor Público , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Criança , Comércio/legislação & jurisprudência , Feminino , Inquéritos Epidemiológicos , Humanos , Legislação de Medicamentos/estatística & dados numéricos , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Prevalência , Medição de Risco , Estudantes/estatística & dados numéricos , Washington/epidemiologia
8.
Rev Saude Publica ; 53: 90, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644771

RESUMO

OBJECTIVE: The new regulatory framework for dietary supplements in Brazil prompted this analysis of the current outlook of these products and the challenges posed by the new guidelines. METHODS: We conducted a qualitative, observational and descriptive study of dietary supplements commercialized in Brazilian online stores with the help of the Google® search tool. We considered the ingredients on the labels, the effects attributed to these products and the commercial claims used as a means of promoting them to assess the necessary changes for the legal framework in the new guidelines. Finally, with the help of a database, we compared the effects declared by the manufacturers and attributed to certain ingredients with the scientific evidence described in literature. RESULTS: In total, we purchased 44 dietary supplements from Brazilian online stores (n = 7). Of the samples studied, 34.2% could not be classified in the category Dietary Supplements, as recommended by the new regulation of the Brazilian Health Regulatory Agency due to the presence of prohibited substances; 16% of products should be commercialized as medicines. Regarding the commercial appeals, 97.7% had banned expressions. Numerous claims of effects attributed to certain products were characterized as consumer fraud because they have no scientific evidence. CONCLUSIONS: The necessary changes represent a major regulatory and production challenge due to the wide range of dietary supplements and markets, an effort that aims to protect the consumers' health. Some previous gaps in the regulatory framework were not fully solved.


Assuntos
Comércio/legislação & jurisprudência , Suplementos Nutricionais , Rotulagem de Produtos/legislação & jurisprudência , Brasil , Comércio/normas , Suplementos Nutricionais/normas , Ingredientes de Alimentos/normas , Humanos , Legislação sobre Alimentos/normas , Rotulagem de Produtos/normas , Saúde Pública , Pesquisa Qualitativa
10.
Health Policy Plan ; 34(7): 520-528, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381805

RESUMO

In response to Mexico's burgeoning industrial epidemics of obesity and type-2 diabetes, triggered in part by sugar-sweetened carbonated beverages' ability to readily market their products and influence consumption, the government has responded through a variety of non-communicable disease (NCD) policies. Nevertheless, major industries, such as Coca-Cola, have been able to continuously obstruct the prioritization of those policies targeting the consumption, marketing and sale of their products. To better understand why this has occurred, this article introduces a political science agenda-setting framework and applies it to the case of Coca-Cola in Mexico. Devised from political science theory and subsequently applied to the case of Coca-Cola in Mexico, my framework, titled Institutions, Interests, and Industry Civic Influence (IPIC), emphasizes Coca-Cola's access to institutions, supportive presidents and industry efforts to hamper civic mobilization and pressures for greater regulation of the soda industry. Methodologically, I employ qualitative single case study analysis, combining an analysis of 26 case study documents and seven in-depth stake-holder interviews. My proposed analytical framework helps to underscore the fact that Coca-Cola's influence is not solely shaped by the corporation's increased economic importance, but more importantly, its access to politicians, institutions and strategies to divide civil society. Additionally, my proposed framework provides several real-world policy recommendations for how governments and civil society can restructure their relationship with the soda industry, such as the government's creation of laws prohibiting the industry's ability to influence NCD policy and fund scientific research.


Assuntos
Bebidas Gaseificadas/legislação & jurisprudência , Comércio/organização & administração , Política de Saúde , Política , Bebidas Gaseificadas/economia , Comércio/economia , Comércio/legislação & jurisprudência , Diabetes Mellitus Tipo 2/prevenção & controle , Humanos , México , Obesidade/prevenção & controle
12.
BMC Health Serv Res ; 19(1): 536, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366363

RESUMO

BACKGROUND: Many low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses. METHODS: Both PubMed and Embase were systematically searched for studies reporting on impact measurement in moving towards prescription only access to antibiotics in LMICs. The PRISMA methodological review framework was used to ensure systematic data collection and analysis of literature. Narrative data synthesis was used due to heterogeneity of study designs. RESULTS: In total, 15 studies were included that assessed policy impact in 10 different countries. Strategies employed to enforce regulations prohibiting OTC sales of systemic antibiotics included retention of prescriptions for antibiotics by pharmacies, government inspections, engaging pharmacists in the design of interventions, media campaigns for the general public and educational activities for health care workers. A variety of outcomes was used to assess the policy impact; changes in antimicrobial resistance rates, changes in levels of antibiotic use, changes in trends of antibiotic use, changes in OTC supply of antibiotics, and changes in reported practices and knowledge of pharmacists, medicine sellers and the general public. Differences in methodological approaches and outcome assessment made it difficult to compare the effectiveness of law enforcement activities. Most effective appeared to be multifaceted approaches that involved all stakeholders. Monitoring of the impact on total sales of antibiotics by means of an interrupted time series (ITS) analysis and analysis of pharmacies selling antibiotics OTC using mystery clients were the methodologically strongest designs used. CONCLUSIONS: The published literature describing activities to enforce prescription-only access to antibiotics in LMICs is sparse and offers limited guidance. Most likely to be effective are comprehensive multifaceted interventions targeting all stakeholders with regular reinforcement of messages. Policy evaluation should be planned as part of implementation to assess the impact and effectiveness of intervention strategies and to identify targets for further activities. Robust study designs such as ITS analyses and mystery client surveys should be used to monitor policy impact.


Assuntos
Antibacterianos , Comércio/legislação & jurisprudência , Aplicação da Lei , Legislação de Medicamentos , Medicamentos sem Prescrição , Comércio/estatística & dados numéricos , Países em Desenvolvimento , Humanos , Análise de Séries Temporais Interrompida
13.
Global Health ; 15(1): 46, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296242

RESUMO

Non-communicable diseases in general and cardiovascular diseases in particular are a leading cause of death globally. Trans-fat consumption is a significant risk factor for cardiovascular diseases. The World Health Organization's 'REPLACE' action package of 2018 aims to eliminate it completely in the global food supply by 2023. Legislative and other regulatory actions (i.e., banning trans-fat) are considered as effective means to achieve such a goal. Both wealthier and poorer countries are taking or considering action, as shown by the United States food regulations and Cambodian draft food legislation discussed in this paper. This paper reviews these actions and examines public and private stakeholders' incentives to increase health-protecting or health-promoting standards and regulations at home and abroad, setting the ground for further research on the topic. It focuses on the potential of trade incentives as a potential driver of a 'race to the top'. While it has been documented that powerful countries use international trade instruments to weaken other countries' national regulations, at times these powerful countries may also be interested in more stringent regulations abroad to protect their exports from competition from third countries with less stringent regulations. This article explores practical and principled considerations on how such a dynamic may spread trans-fat restrictions globally. It argues that trade dynamics and public health considerations within powerful countries may help to promote anti-trans-fat regulation globally but will not be sufficient and is ethically questionable. True international regulatory cooperation is needed and could be facilitated by the World Health Organization. Nevertheless, the paper highlights that international trade and investment law offers opportunities for anti-trans-fat policy diffusion globally.


Assuntos
Comércio/legislação & jurisprudência , Saúde Global , Direito Internacional , Doenças não Transmissíveis/prevenção & controle , Ácidos Graxos Trans/efeitos adversos , Humanos , Doenças não Transmissíveis/epidemiologia
14.
BMC Public Health ; 19(1): 1010, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357967

RESUMO

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/terapia , Comércio/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Menores de Idade/legislação & jurisprudência , Consumo de Álcool por Menores/legislação & jurisprudência , Ferimentos e Lesões/terapia , Adolescente , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Concentração Alcoólica no Sangue , Criança , Feminino , Humanos , Illinois/epidemiologia , Masculino , Menores de Idade/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
15.
PLoS One ; 14(6): e0218161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220108

RESUMO

BACKGROUND: Restrictive practices on alcohol sales in entertainment districts have been introduced to reduce alcohol-related violence in youth. On 1st July 2016, the Queensland State Government (Australia) imposed a 2-hour reduction in trading hours for alcohol sales in venues within specific night-time entertainment districts (NEDS; from 5am to 3am), a reduction in maximum trading hours for venues outside NEDs (with a maximum 2am closing time), the banning of 'rapid intoxication drinks' (e.g. shots) after 12am, and no new approvals for trading hours beyond 10pm for the sale of takeaway alcohol. No independent study has evaluated general levels of intoxication, crowd numbers, fear of violence, and illicit substance use as people enter and exit NEDS, both before and after the introduction of restrictive legislation. Further, no study has assessed the impact using matched times of the year in a controlled study and also assessed actual assault rates as recorded by the police. METHOD: We conducted 3 studies-randomly breath-testing patrons for alcohol, as they entered and exited NEDs. Study 1 assessed patrons' (n = 807) breath approximated blood alcohol concentration (BrAC) and predictions of how the legislation would change their drinking habits before the legislation was enacted. Study 2 assessed crime statistics and patrons' BrAC levels and drug taking reports on an equivalent night, one year apart-before (n = 497) and after (n = 406) the new legislation. Study 3 was a test of the generalisation of Study 2 with two months of survey and BrAC data collected as people entered and exited the NEDs over two consecutive years before (n = 652 and n = 155) and one year after (n = 460) the new legislation. In Study 3 we also collected crime statistics and data on people leaving the entertainment district one year before (n = 502) and one year after (n = 514) the legislative change. FINDINGS: People predicted that the legislation would lead to them drinking more alcohol before they entered town or make little change to their drinking habits. Baseline data over the 2 years before the legislation (Study 3) demonstrated stable preloading rates and BrAC at entry to the NEDs. However, after the introduction of the legislation patrons entered the NEDs systematically later and increased their alcohol preloading. People were substantially more inebriated as they entered the NEDs after the legislative change, with approximately 50% fewer people not preloading after the new laws. Exit BrAC was less consistent but showed some evidence of an increase. Crime statistics and patrons' self-reported experiences of violence did not change. INTERPRETATION: Legislation that does not specifically adapt to the cultural shift of preloading and take local conditions into account will be unsuccessful in reducing alcohol consumption. Such legislation is unlikely to meaningfully change assault rates in youth.


Assuntos
Consumo de Bebidas Alcoólicas , Comércio/legislação & jurisprudência , Crime/legislação & jurisprudência , Adulto , Testes Respiratórios , Feminino , Humanos , Masculino , Queensland , Inquéritos e Questionários , Violência
17.
BMC Public Health ; 19(1): 825, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242893

RESUMO

BACKGROUND: Policymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets, or banning the display of tobacco products. Many studies have assessed the impact of these policies, while less is known about the preceding policy process. The aim of our review was to assess the available evidence on the preceding process of agenda setting, policy formulation, and policy legitimation. METHODS: A systematic literature search was conducted using the PubMed and the Social Sciences Citation Index databases. After selection, 200 international peer-reviewed articles were identified and analyzed. Through a process of close reading, evidence based on scientific enquiry and anecdotal evidence on agenda setting, policy formulation and policy legitimation was abstracted from each article. RESULTS: Scientific evidence on the policy process is scarce for these policies, as most of the evidence found was anecdotal. Only one study provided evidence based on a scientific analysis of data on the agenda setting and legitimation phases of policy processes that led to the adoption of display bans in two Australian jurisdictions. CONCLUSION: The processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy.


Assuntos
Saúde do Adolescente , Formulação de Políticas , Política Pública , Prevenção do Hábito de Fumar , Indústria do Tabaco , Produtos do Tabaco , Fumar Tabaco/prevenção & controle , Adolescente , Fatores Etários , Austrália , Comércio/legislação & jurisprudência , Promoção da Saúde/métodos , Humanos , Marketing/legislação & jurisprudência , Países Baixos , Prevenção do Hábito de Fumar/legislação & jurisprudência , Tabaco , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Fumar Tabaco/legislação & jurisprudência
18.
Public Health ; 173: 1-4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203136

RESUMO

OBJECTIVE: The short communication is prompted by the debate relating to the effect of pharmaceutical patents on access to affordable medicines, particularly in Africa. A recent amendment made to the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement creates a policy space for the regional alliance of low-income countries for the collective procurement and local production of drugs under compulsory licensing. This article examines the extent to which the regional mechanism can deliver access to pharmaceuticals. The article examines the regional mechanism in the light of the recent regional trade agreements and pharmaceutical plans of some regional economic blocs in Africa as well as the newly signed African Continental Free Trade Agreement (AfCFTA). STUDY DESIGN: This short communication adopts a descriptive approach in linking the regional mechanism in the TRIPS amendment to the regional trade agreements of African countries at the subregional and continental levels. METHODS: To ascertain the extent to which TRIPS Agreements regional model can deliver access to medicines in Africa, the article adopts a desk review approach by examining the relevant provisions of TRIPS Agreement, particularly the newly added Article 31bis, and the provisions of the relevant regional and continental free trade agreements in Africa. RESULTS: The article finds that although the regional model has great prospects in supporting the wider effort to deliver access to medicine, the limitations to its operative utilization may weaken its potency in addressing the urgent public health needs of the continent. CONCLUSION: The article concludes by stressing the inevitability of Africa's integration in tackling the deficiency of access to generic medicines in Africa. It was noted that even though there could be some potential challenges, the regional mechanism is indeed the way to go for low-income countries.


Assuntos
Acesso aos Serviços de Saúde , Propriedade Intelectual , Cooperação Internacional , Preparações Farmacêuticas/provisão & distribução , Saúde Pública , África , Comércio/economia , Comércio/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Cooperação Internacional/legislação & jurisprudência , Patentes como Assunto/legislação & jurisprudência , Preparações Farmacêuticas/economia , Políticas , Pobreza
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