Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo

Detalhes bibliográficos
Autor(a) principal: Santos, Ana Paula Brioschi Dos
Data de Publicação: 2024
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
Texto Completo: http://repositorio.ufes.br/handle/10/17315
Resumo: Introduction: The Coronavirus disease (COVID-19), caused by SARS-CoV2, was declared a pandemic by the World Health Organization (WHO) in 2020. Pregnancy was not initially considered a risk group, however, it was noticed that when infected, pregnant women were more likely to present a more severe clinical picture and death compared to non-pregnant reproductive-aged women, especially among low- and middle-income countries. Objective: To analyze the effects of COVID-19 on maternal and infant outcomes and the quality of data from 2020 to 2022 in Espírito Santo. Methodology: To achieve the objectives, three stages were carried out in the study. The first stage was a descriptive study using data obtained from e-SUS VS. Completeness in filling out the notification was classified as excellent (less than 5% incomplete filling), good (5% to 10%), fair (10% to 20%), poor (20% to 50%), or very poor (50% or more). The timeliness was defined by the difference between the dates of symptom onset and notification. The second stage was a retrospective cohort study among pregnant women with secondary data from the National Live Birth Information System (SINASC), the National Mortality Information System (SIM), and the e-SUS Surveillance Health System. Pregnant women confirmed for COVID-19 had a positive RT-PCR between March 2020 and May 2021, while pregnant women without COVID-19 were those without notification for the disease. Maternal death, fetal death, and stillbirth were evaluated as primary outcomes. In the third stage, a case-control study was conducted from a historical cohort of pregnant women confirmed for COVID-19 in the state of Espírito Santo between 2020 and March 2022. Cases were selected from maternal deaths confirmed by COVID-19 registered in e-SUS VS and SIM, and controls were selected from the cohort of pregnant women confirmed for COVID-19 who were cured of the disease. Results: In the first stage of the study, 8,989 notifications in pregnant women were identified. The notification for COVID-19 in e-SUS VS has 59 variables, the completeness of 53 (89.83%) variables was excellent, good, or fair in 1 (1.70%), and poor in 4 (6.77%). The timeliness had an average of 3.37 days. In the second stage, 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19 were included. Among pregnant women with COVID-19, 1,013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were of mixed race, 907 (65.4%) had ≥ 8 years of schooling, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyzes, COVID-19 in pregnancy presented a higher risk of maternal death (relative risk [RR] 18.73 - 95% confidence interval [CI95%] 11.07-31.69), fetal death/stillbirth (RR 1.96 - CI95% 1.18 -3.25), premature birth [RR 1.18-CI95% 1.01-1.39], cesarean section (RR 1.07 - CI95% 1.02-1.11), and cesarean section before the onset of labor (RR 1.33 - CI95% 1.23-1.44). In the third stage, the sample consisted of 2,300 pregnant women, the matching of cases and controls was performed, and 37 cases and 111 controls were selected. Among the pregnant women who died, 35 (67.57%) were non-white, 26 (70.27%) had ≥ 8 years of study. 27 (72.97%) were infected in the 3rd gestational trimester, 24 (77.42%) had up to 6 prenatal consultations, and 15 (48.39%) had 3 or more previous pregnancies. Regarding the vaccination status among the deaths, 3 (8.11%) were vaccinated during pregnancy, and 36 (97.30%) had a record of COVID19 infection before the first vaccine dose, 40.54% had adynamia, and 13 (35.14%) of the pregnant women who died presented at least 1 comorbidity. In the adjusted model, the highest chance of maternal death was described among pregnant women infected in the third gestational trimester (OR 4.67 - CI95% 1.51-14.46), with adynamia (OR 4.33 - CI95% 1.41- 13.31) with at least one comorbidity in pregnancy (OR 3.82 - CI95% 1.16-12.55). Having more than 7 prenatal consultations remained with the lowest chance of progressing to death (OR 0.91 - CI95% 0.31-0.26). Conclusion: The quality of data regarding pregnant women registered in e-SUS VS was excellent. COVID-19 can contribute to unfavorable outcomes in pregnancy. The results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, premature birth, cesarean section, and cesarean section before the onset of labor. Factors related to prenatal care, exposure to the virus in the third trimester of pregnancy, as well as factors related to pre-existing diseases and conditions in pregnant women infected with SARS-CoV-2, increase the chance of maternal death.
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spelling Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santotitle.alternativeCovid-19gestantemorte maternasubject.br-rjbnÁrea(s) do conhecimento do documento (Tabela CNPq)Introduction: The Coronavirus disease (COVID-19), caused by SARS-CoV2, was declared a pandemic by the World Health Organization (WHO) in 2020. Pregnancy was not initially considered a risk group, however, it was noticed that when infected, pregnant women were more likely to present a more severe clinical picture and death compared to non-pregnant reproductive-aged women, especially among low- and middle-income countries. Objective: To analyze the effects of COVID-19 on maternal and infant outcomes and the quality of data from 2020 to 2022 in Espírito Santo. Methodology: To achieve the objectives, three stages were carried out in the study. The first stage was a descriptive study using data obtained from e-SUS VS. Completeness in filling out the notification was classified as excellent (less than 5% incomplete filling), good (5% to 10%), fair (10% to 20%), poor (20% to 50%), or very poor (50% or more). The timeliness was defined by the difference between the dates of symptom onset and notification. The second stage was a retrospective cohort study among pregnant women with secondary data from the National Live Birth Information System (SINASC), the National Mortality Information System (SIM), and the e-SUS Surveillance Health System. Pregnant women confirmed for COVID-19 had a positive RT-PCR between March 2020 and May 2021, while pregnant women without COVID-19 were those without notification for the disease. Maternal death, fetal death, and stillbirth were evaluated as primary outcomes. In the third stage, a case-control study was conducted from a historical cohort of pregnant women confirmed for COVID-19 in the state of Espírito Santo between 2020 and March 2022. Cases were selected from maternal deaths confirmed by COVID-19 registered in e-SUS VS and SIM, and controls were selected from the cohort of pregnant women confirmed for COVID-19 who were cured of the disease. Results: In the first stage of the study, 8,989 notifications in pregnant women were identified. The notification for COVID-19 in e-SUS VS has 59 variables, the completeness of 53 (89.83%) variables was excellent, good, or fair in 1 (1.70%), and poor in 4 (6.77%). The timeliness had an average of 3.37 days. In the second stage, 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19 were included. Among pregnant women with COVID-19, 1,013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were of mixed race, 907 (65.4%) had ≥ 8 years of schooling, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyzes, COVID-19 in pregnancy presented a higher risk of maternal death (relative risk [RR] 18.73 - 95% confidence interval [CI95%] 11.07-31.69), fetal death/stillbirth (RR 1.96 - CI95% 1.18 -3.25), premature birth [RR 1.18-CI95% 1.01-1.39], cesarean section (RR 1.07 - CI95% 1.02-1.11), and cesarean section before the onset of labor (RR 1.33 - CI95% 1.23-1.44). In the third stage, the sample consisted of 2,300 pregnant women, the matching of cases and controls was performed, and 37 cases and 111 controls were selected. Among the pregnant women who died, 35 (67.57%) were non-white, 26 (70.27%) had ≥ 8 years of study. 27 (72.97%) were infected in the 3rd gestational trimester, 24 (77.42%) had up to 6 prenatal consultations, and 15 (48.39%) had 3 or more previous pregnancies. Regarding the vaccination status among the deaths, 3 (8.11%) were vaccinated during pregnancy, and 36 (97.30%) had a record of COVID19 infection before the first vaccine dose, 40.54% had adynamia, and 13 (35.14%) of the pregnant women who died presented at least 1 comorbidity. In the adjusted model, the highest chance of maternal death was described among pregnant women infected in the third gestational trimester (OR 4.67 - CI95% 1.51-14.46), with adynamia (OR 4.33 - CI95% 1.41- 13.31) with at least one comorbidity in pregnancy (OR 3.82 - CI95% 1.16-12.55). Having more than 7 prenatal consultations remained with the lowest chance of progressing to death (OR 0.91 - CI95% 0.31-0.26). Conclusion: The quality of data regarding pregnant women registered in e-SUS VS was excellent. COVID-19 can contribute to unfavorable outcomes in pregnancy. The results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, premature birth, cesarean section, and cesarean section before the onset of labor. Factors related to prenatal care, exposure to the virus in the third trimester of pregnancy, as well as factors related to pre-existing diseases and conditions in pregnant women infected with SARS-CoV-2, increase the chance of maternal death.Introdução: A doença do Coronavírus (COVID-19), causada pelo SARS-CoV2, foi declarada como Pandemia pela Organização Mundial de Saúde (OMS) em 2020. A gestante inicialmente não foi grupo de risco, porém, percebeu-se que grávidas quando infectadas estavam mais propensas a um quadro mais grave e óbito em comparação às mulheres em idade reprodutiva não grávidas, além dos mecanismos fisiopatológicos que a doença traz de agravamento existe também um agravamento relacionado a vulnerabilidade social, principalmente entre países de baixa e média renda. Objetivos: Analisar os efeitos da COVID-19 nos desfechos maternos e infantis e a qualidade dos dados entre 2020 a 2022 no Espírito Santo. Metodologia: Para alcançar os objetivos foram realizadas três estudo, primeiro um estudo descritivo utilizando-se de dados obtidos do e-SUS VS, avaliou-se a completude no preenchimento da notificação que foi classificada como excelente (menos de 5% de preenchimento incompleto), bom (5% a 10%),regular (10% a 20%), ruim (20% a 50%) ou muito ruim (50% ou mais), analisamos também a oportunidade da notificação que foi definida pela diferença entre as datas do início de sintomas e a notificação. No segundo estudo foi realizada uma coorte retrospectiva entre gestantes utilizando dados secundários do Sistema Nacional de Nascidos Vivos (SINASC), Sistema Nacional de Mortalidade (SIM), e Sistema de Vigilância em Saúde e-SUS (e-SUS VS), foram incluídas gestantes confirmadas para COVID-19 que tinham RT-PCR positivo entre março de 2020 e maio de 2021, gestantes sem COVID- 19 foram aquelas sem notificação para doença. O desfecho primário analisado foi a morte materna, morte fetal e natimorto. No terceiro estudo, realizou-se um estudo caso controle a partir de uma coorte histórica de gestantes confirmadas para COVID-19 entre os anos de 2020 a março de 2022. Os casos foram os óbitos maternos confirmados por COVID-19 registrados no e-SUS VS e no SIM e os controles foram gestantes confirmadas para COVID-19 e que evoluíram para a cura da doença. Resultados: No primeiro estudo identificou-se 8.989 notificações em gestantes. A notificação para COVID-19 do e-SUS VS possui 59 variáveis, a completude de 53 (89,83%) variáveis foi excelente, boa e regular em 1 (1,70%), e ruim em 4 (6,77%), a oportunidade de notificação obteve média de 3,37 dias. No segundo estudo foram analisadas 68.673 gestantes não notificadas como suspeita de COVID-19 e 1.386 com diagnóstico confirmado de COVID-19. Entre as gestantes com COVID-19, 1.013 (73,0%) tinham de 20 a 34 anos, 655 (47,2%) eram pardas, 907 (65,4%) tinham ≥ 8 anos de escolaridade, no terceiro trimestre de gestação (41,5%), submetida à cesariana (64,5%). Em análises ajustadas, a COVID-19 na gravidez apresentou maior risco de morte materna (risco relativo [RR] 18,73 - intervalo de confiança de 95% [IC95%] 11,07- 31,69), morte fetal/natimorto (RR 1,96 - IC95% 1,18 -3,25), nascimento prematuro [RR 1,18-IC95% 1,01-1,39], parto cesáreo (RR 1,07 - IC95% 1,02-1,11) e parto cesáreo ocorrido antes do início do trabalho de parto (RR 1,33 - IC95% 1,23-1,44). No terceiro estudo foram notificadas 2.030 gestantes, das quais elecionadas 37 casos e 111 controles. Entre as gestantes que foram a óbito 35 (67,57%) eram não brancas 26 (70,27%) tinham ≥ 8 anos de estudo. 27 (72,97%) foram infectadas no 3º trimestre gestacional, 24 (77,42%) tinham até 6 consultas de pré-natal e 15 (48,39%) tinham 3 ou mais gestações anteriores. Entre os óbitos3 (8,11%) realizaram a vacinação ainda na gestação, e 36 (97,30%) tinham o registro de infecção pelo COVID-19 antes da primeira dose da vacina. 40,54% relataram adinamia e 13 (35,14%) das gestantes que evoluíram a óbito apresentaram pelo menos 1 comorbidade. No modelo ajustado a maior chance de óbito materno foi descrita entre as gestantes infectada no terceiro trimestre gestacional (OR 4,67 – IC95% 1,51-14,46), com adinamia (OR 4,33 – IC95% 1,41- 13,31) com ao menos uma comorbidade na gestação (OR 3,82 – IC95% 1,16- 12,55). Já ter mais de 7 consultas de pré-natal se manteve com a menor chance de evoluir a óbito (OR 0,91 – IC95% 0,31- 0,26). Conclusão: A qualidade de dados referente a gestante registrada no e-SUS VS foi excelente. A COVID-19 contribui para desfechos desfavoráveis na gravidez, os resultados mostraram que as mulheres grávidas infectadas com SARS-CoV-2 apresentavam maior risco de morte materna, morte fetal/natimorto, parto prematuro, parto cesáreo e cesariana ocorrida antes do início do trabalho de parto, além de fatores ligados à assistência ao pré-natal, à exposição ao vírus no terceiro trimestre de gestação, bem como a fatores ligados a doenças e agravos já pré-existentes na gestantes infectadas pelo SARS-CoV-2 aumentam a chance de óbito materno.Agência(s) de fomentoUniversidade Federal do Espírito SantoBRDoutorado em Saúde ColetivaCentro de Ciências da SaúdeUFESPrograma de Pós-Graduação em Saúde ColetivaVicente, Creuza Rachelhttps://orcid.org/0000-0003-0182-7969http://lattes.cnpq.br/0530544422426629Miranda, Angelica Espinosahttps://orcid.org/0000-0002-5556-8379http://lattes.cnpq.br/5842271060162462https://orcid.org/0000-0002-9701-0314http://lattes.cnpq.br/5392815933543240Brito, Ana Maria dehttps://orcid.org/0000-0003-4347-6730http://lattes.cnpq.br/0105337613337822Pinto Neto, Lauro Ferreira da Silvahttps://orcid.org/0000-0003-2964-8516http://lattes.cnpq.br/1528710938091794Prado, Thiago Nascimento dohttps://orcid.org/0000-0001-8132-6288http://lattes.cnpq.br/6388559394015871Almeida, Márcia Valéria de Souza https://orcid.org/0000-0002-1318-7084http://lattes.cnpq.br/9372951429429767Santos, Ana Paula Brioschi Dos2024-06-14T11:27:59Z2024-06-14T11:27:59Z2024-04-23info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTextapplication/pdfhttp://repositorio.ufes.br/handle/10/17315porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)instname:Universidade Federal do Espírito Santo (UFES)instacron:UFES2024-08-29T11:25:00Zoai:repositorio.ufes.br:10/17315Repositório InstitucionalPUBhttp://repositorio.ufes.br/oai/requestopendoar:21082024-08-29T11:25Repositório Institucional da Universidade Federal do Espírito Santo (riUfes) - Universidade Federal do Espírito Santo (UFES)false
dc.title.none.fl_str_mv Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
title.alternative
title Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
spellingShingle Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
Santos, Ana Paula Brioschi Dos
Covid-19
gestante
morte materna
subject.br-rjbn
Área(s) do conhecimento do documento (Tabela CNPq)
title_short Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
title_full Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
title_fullStr Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
title_full_unstemmed Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
title_sort Covid-19 Em Gestantes E Recém-Nascidos: Situação Epidemiológica Do Espírito Santo
author Santos, Ana Paula Brioschi Dos
author_facet Santos, Ana Paula Brioschi Dos
author_role author
dc.contributor.none.fl_str_mv Vicente, Creuza Rachel
https://orcid.org/0000-0003-0182-7969
http://lattes.cnpq.br/0530544422426629
Miranda, Angelica Espinosa
https://orcid.org/0000-0002-5556-8379
http://lattes.cnpq.br/5842271060162462
https://orcid.org/0000-0002-9701-0314
http://lattes.cnpq.br/5392815933543240
Brito, Ana Maria de
https://orcid.org/0000-0003-4347-6730
http://lattes.cnpq.br/0105337613337822
Pinto Neto, Lauro Ferreira da Silva
https://orcid.org/0000-0003-2964-8516
http://lattes.cnpq.br/1528710938091794
Prado, Thiago Nascimento do
https://orcid.org/0000-0001-8132-6288
http://lattes.cnpq.br/6388559394015871
Almeida, Márcia Valéria de Souza
https://orcid.org/0000-0002-1318-7084
http://lattes.cnpq.br/9372951429429767
dc.contributor.author.fl_str_mv Santos, Ana Paula Brioschi Dos
dc.subject.por.fl_str_mv Covid-19
gestante
morte materna
subject.br-rjbn
Área(s) do conhecimento do documento (Tabela CNPq)
topic Covid-19
gestante
morte materna
subject.br-rjbn
Área(s) do conhecimento do documento (Tabela CNPq)
description Introduction: The Coronavirus disease (COVID-19), caused by SARS-CoV2, was declared a pandemic by the World Health Organization (WHO) in 2020. Pregnancy was not initially considered a risk group, however, it was noticed that when infected, pregnant women were more likely to present a more severe clinical picture and death compared to non-pregnant reproductive-aged women, especially among low- and middle-income countries. Objective: To analyze the effects of COVID-19 on maternal and infant outcomes and the quality of data from 2020 to 2022 in Espírito Santo. Methodology: To achieve the objectives, three stages were carried out in the study. The first stage was a descriptive study using data obtained from e-SUS VS. Completeness in filling out the notification was classified as excellent (less than 5% incomplete filling), good (5% to 10%), fair (10% to 20%), poor (20% to 50%), or very poor (50% or more). The timeliness was defined by the difference between the dates of symptom onset and notification. The second stage was a retrospective cohort study among pregnant women with secondary data from the National Live Birth Information System (SINASC), the National Mortality Information System (SIM), and the e-SUS Surveillance Health System. Pregnant women confirmed for COVID-19 had a positive RT-PCR between March 2020 and May 2021, while pregnant women without COVID-19 were those without notification for the disease. Maternal death, fetal death, and stillbirth were evaluated as primary outcomes. In the third stage, a case-control study was conducted from a historical cohort of pregnant women confirmed for COVID-19 in the state of Espírito Santo between 2020 and March 2022. Cases were selected from maternal deaths confirmed by COVID-19 registered in e-SUS VS and SIM, and controls were selected from the cohort of pregnant women confirmed for COVID-19 who were cured of the disease. Results: In the first stage of the study, 8,989 notifications in pregnant women were identified. The notification for COVID-19 in e-SUS VS has 59 variables, the completeness of 53 (89.83%) variables was excellent, good, or fair in 1 (1.70%), and poor in 4 (6.77%). The timeliness had an average of 3.37 days. In the second stage, 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19 were included. Among pregnant women with COVID-19, 1,013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were of mixed race, 907 (65.4%) had ≥ 8 years of schooling, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyzes, COVID-19 in pregnancy presented a higher risk of maternal death (relative risk [RR] 18.73 - 95% confidence interval [CI95%] 11.07-31.69), fetal death/stillbirth (RR 1.96 - CI95% 1.18 -3.25), premature birth [RR 1.18-CI95% 1.01-1.39], cesarean section (RR 1.07 - CI95% 1.02-1.11), and cesarean section before the onset of labor (RR 1.33 - CI95% 1.23-1.44). In the third stage, the sample consisted of 2,300 pregnant women, the matching of cases and controls was performed, and 37 cases and 111 controls were selected. Among the pregnant women who died, 35 (67.57%) were non-white, 26 (70.27%) had ≥ 8 years of study. 27 (72.97%) were infected in the 3rd gestational trimester, 24 (77.42%) had up to 6 prenatal consultations, and 15 (48.39%) had 3 or more previous pregnancies. Regarding the vaccination status among the deaths, 3 (8.11%) were vaccinated during pregnancy, and 36 (97.30%) had a record of COVID19 infection before the first vaccine dose, 40.54% had adynamia, and 13 (35.14%) of the pregnant women who died presented at least 1 comorbidity. In the adjusted model, the highest chance of maternal death was described among pregnant women infected in the third gestational trimester (OR 4.67 - CI95% 1.51-14.46), with adynamia (OR 4.33 - CI95% 1.41- 13.31) with at least one comorbidity in pregnancy (OR 3.82 - CI95% 1.16-12.55). Having more than 7 prenatal consultations remained with the lowest chance of progressing to death (OR 0.91 - CI95% 0.31-0.26). Conclusion: The quality of data regarding pregnant women registered in e-SUS VS was excellent. COVID-19 can contribute to unfavorable outcomes in pregnancy. The results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, premature birth, cesarean section, and cesarean section before the onset of labor. Factors related to prenatal care, exposure to the virus in the third trimester of pregnancy, as well as factors related to pre-existing diseases and conditions in pregnant women infected with SARS-CoV-2, increase the chance of maternal death.
publishDate 2024
dc.date.none.fl_str_mv 2024-06-14T11:27:59Z
2024-06-14T11:27:59Z
2024-04-23
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://repositorio.ufes.br/handle/10/17315
url http://repositorio.ufes.br/handle/10/17315
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv Text
application/pdf
dc.publisher.none.fl_str_mv Universidade Federal do Espírito Santo
BR
Doutorado em Saúde Coletiva
Centro de Ciências da Saúde
UFES
Programa de Pós-Graduação em Saúde Coletiva
publisher.none.fl_str_mv Universidade Federal do Espírito Santo
BR
Doutorado em Saúde Coletiva
Centro de Ciências da Saúde
UFES
Programa de Pós-Graduação em Saúde Coletiva
dc.source.none.fl_str_mv reponame:Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
instname:Universidade Federal do Espírito Santo (UFES)
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instname_str Universidade Federal do Espírito Santo (UFES)
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repository.name.fl_str_mv Repositório Institucional da Universidade Federal do Espírito Santo (riUfes) - Universidade Federal do Espírito Santo (UFES)
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