Before and after case reporting: A comparison of the knowledge, attitude and practices of the Jordanian population towards COVID-19

Public Awareness of Palliative Care: A Nationally Representative Sample of Jordanian Adults

CONTEXT

Internationally, studies suggest that inadequate comprehension of the concept of palliative care and misconceptions about it hinder the effective use of palliative care, especially in developing nations.

OBJECTIVE

To assess the awareness of the adult population in Jordan regarding palliative care.

METHODS

The study used a cross-sectional design and an online self-administered questionnaire survey. The recruitment method was convenience snowball sampling of three thousand nine hundred forty-two Jordanian adults covering 12 governorates. Participants were recruited through social media platforms like Facebook and WhatsApp. The process of gathering data commenced in October -December 2023. Descriptive statistics were computed.

RESULTS

A study of 3942 respondents in Jordan found that 45% have some knowledge of palliative care, with 31% being pretty knowledgeable. Most respondents (89%) strongly agree that patients with incurable illnesses should receive palliative care, with cancer patients showing the highest level of agreement (96%). The most agreed-upon aspect of palliative care is controlling pain and symptoms at home, while the least agreed-upon aspect is providing information on benefits and financial matters. The study also highlighted the link between palliative care and mortality, suggesting the need for increased awareness and education.

CONCLUSION

The demand for palliative care in Jordan is increasing, requiring increased access, a holistic approach, open discussions, and easily accessible information. Challenges include integrating palliative care into non-malignant progressive diseases, ensuring comprehensive end-of-life care, promoting societal receptiveness towards mortality, enhancing information accessibility, and health promotion efforts. The study's results indicate the importance of implementing educational strategies and engaging families and communities in policymaking to change public knowledge and attitudes toward palliative care.

Factors Associated to Community Practices Toward the COVID-19 Pandemic: A Cross-Sectional Study in Indonesia

Background

COVID-19 still continue to spread and affects most nations globally to date. In this context, community knowledge, attitudes, and practices (KAP) toward COVID-19 are the most important for controlling and preventing the infectious pandemic disease.

Objective

This study aimed to investigate the factors associated with community practices related to COVID-19.

Methods

Cross-sectional study was conducted on 330 residents of Sumedang District, Indonesia. Selection of the sample using stratified random sampling. KAP toward COVID-19 was measured using the WHO questionnaire which is valid and reliable. The data were analyzed using the Rasch model, Pearson correlation, and linear regression.

Results

This study revealed that most respondents tend to answer correctly on the sociality and disease transmission knowledge (+2.08 logit; SE 1.63), incorrectly in conceptual knowledge (logit measure -2.05; SE 0.45), tended to have a positive attitude (+1.6 logit; 0.54) and practice (+1.63 logit; SE 0.61). Based on the results of the Wright map, the most challenging statement for respondents was to use masks. Knowledge and attitude were significantly associated with the practice of COVID-19 prevention (p<0.001). Attitude is the dominant factor influencing society practice towards COVID-19 (Stand. Estimate= 0.2737; 95% CI=0.1608-0.378; p<0.001) and knowledge play an important role in improving COVID-19 prevention behaviour.

Conclusion

New insight from this research shows that even attitude is the most dominant factor, yet this study also indicated that knowledge is critical for positive attitudes of society to support COVID-19 prevention practices. Since, knowledge is the basis for positive attitudes in preventing the transmission of Covid 19. Therefore, health education that explicates concepts, sociality and disease transmission is important to boost attitudes of the society in the practice of Covid 19 prevention.

General Population's Psychological Perceptions of COVID-19: A Systematic Review

During the COVID-19 pandemic, general population's mental health may be influenced by their perceptions of major pandemic issues. Therefore, a systematic search was conducted to screen out those concerns and analyse the impacts. EBSCO, Scopus and Web of Science were searched for publications from inception to 1 February 2023. Nineteen articles were extracted and four issues were screened out as general population's major concerns, namely "Risk perception", "Government trust", "Media coverage and authenticity", and "Conspiracy theory". The population's perceptions of those issues could affect their mental health by arousing emotional reactions, which vary in different countries, social classes and groups, and would change in different stages of virus outbreak. The findings suggest that the general population's attitudes towards COVID-19-related social issues could affect their psychological health and should receive more concerns. As different issues are related to one another, an integrated solution system is in need, which would be helpful for coping with similar public emergencies in the future.

Knowledge, practice and attitude associated with SARS-CoV-2 Delta Variant among adults in Jordan

COVID-19 infection is a global pandemic health emergency. This contagious disease was caused by the Severe Acute Respiratory Syndrome Coronavirus‑2 (SARS‑CoV-2) which is mutating over time. In 2021, the Delta variant became the most dominant transmissible form. During the crisis, human practice and knowledge were critical in the overall efforts to encompass the outbreak. A cross-sectional, web-based approach was conducted among adults in Jordan to quantify knowledge, attitude, and practices towards SARS-CoV-2 (Delta variant). This research was carried out between 15th April and 15th of May 2021. The study questionnaire consisted of four sections including the participant's demographics, knowledge, practices and attitude. Comparative evaluation of responses was accomplished using a scoring system. Respondents who scored above the mean score (60%) on the item measured were categorized as knowledgeable, having a positive attitude, and good practices. Participants were allocated to one of the three groups; medical, non-medical and others (unemployed and housewives). Data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A variance test to assess the statistical difference between groups was used. Pearson's chi-squared test was applied to compare the variables and identify significant predictors. Of the participants, 308 (66%) were in the age group of 18-25yrs, 392 (84.1%) females, 120 (25.8%) employed and 346 (74.2%) unemployed. The principle source of knowledge was social media (291, 62.4%). Interestingly, participants had adequate overall knowledge. The mean knowledge score was 22.6 (± 0.19), 20.6 (± 0.19), and 21.3 (± 0.18) for the medical, the non-medical and the others group, respectively. Also, participants showed a positive attitude and good practices towards SARS-CoV-2 (Delta variant). The mean practice score for medical, the non-medical and the others groups was 7.35 (± 0.25), 7.38 (± 0.24), 7.35 (± 0.24) and the mean attitude score was 10.8 (± 0.16), 9.4 (± 0.21), 9.5 (± 0.22), respectively. The studied groups generally had good knowledge, positive attitudes and good practices about SARS-CoV-2 (Delta variant). This was expected due to the authorities' successful management of the pandemic and the high educational level of the Jordanian society, bearing in mind the economic and social impact of COVID-19 disease.

Fears and uncertainties of expectant mothers during the COVID-19 pandemic: trying to reclaim control

Purpose

The novel coronavirus disease (COVID-19) outbreak has exponentially spread across the globe and formed one of the greatest health threats in history. Pregnant women are vulnerable, and their vulnerability is amplified by the associated containment measures of the pandemic. In this study, we aim to explore and describe expectant mothers’ experiences during the lockdown of COVID-19.

Method

A qualitative descriptive design was used. Eighteen pregnant and postpartum women were recruited through purposive and snowball sampling. Semi-structured phone call interviews were conducted by a female researcher. Braun and Clarke’s thematic data analysis was followed.

Results

Three main themes are developed: (1) Living with fears and uncertainties amid the COVID-19 pandemic, (2) Lockdown disrupting the normalcy of pregnancy, (3) Trying to control the chaos of life. Five subthemes underlined the three themes.

Conclusion

Findings portrayed expectant mothers’ uncertainties, fears, and the fragility of the healthcare systems in responding to mothers’ needs during the COVID-19 pandemic. Although the pandemic has resulted in disruption of the normalcy of pregnancy, mothers sought adaptive means to protect themselves and maintain control. Governmental authorities and healthcare providers are directly responsible to maintain considerate perinatal care services for expectant mothers during lockdown and crises.

Preventive and Avoidant Behaviors Followed by Jordanians During COVID-19 Pandemic

OBJECTIVE

During the coronavirus disease 2019 (COVID-19), individuals' compliance with protective behaviors was the most effective strategy to break the infection chain and prevent disease spread, even with vaccine availability and use. Understanding protective behaviors within the Jordanian context will shape health promotion campaigns and guide decision-makers to facilitate required resources and support Jordanian citizens. The objective of this study was to identify personal protective (preventive and avoidant) measures used by the Jordanian population during the COVID-19 pandemic to protect themselves from infection.

METHODS

A cross-sectional study with an exploratory, descriptive design was used to collect data using an online self-reported questionnaire from Jordanian people. The survey included the Protection from Infection Scale and the Infection Avoidance Scale.

RESULTS

A total sample of 1053 Jordanian citizens was included in the study. The participants exhibited a moderate level of self-care behaviors and high levels of protective and infection avoidance behaviors. Their most common behaviors were getting enough sleep, wearing masks, washing hands, and avoiding travel to infected areas. Contrariwise, the least adopted behaviors were exercising, wearing gloves, and leaving their jobs or schools.

CONCLUSIONS

During pandemics, policy-makers must understand public concerns and protective behaviors, then provide them with tailored education through health promotion campaigns to enhance healthy behaviors.

Perception, knowledge and attitude towards influenza vaccine during COVID-19 pandemic in Jordanian population

INTRODUCTION

Seasonal influenza is considered as one of the major causes of morbidity and mortality worldwide. This needs solutions to decrease burdens on the healthcare systems especially during the Coronavirus Disease (COVID-19) pandemic. Population knowledge, perception and attitude towards influenza vaccine during COVID-19 pandemic could have a positive impact to decrease mortality, morbidity and burdens on the healthcare system. This study focuses on investigating knowledge, attitude and practice (KAP) of Jordanian adults towards influenza vaccine during COVID-19 pandemic.

METHODS

This cross-sectional study recruited 1112 randomly selected Jordanian adults. A four-part questionnaire was designed and included questions about the demographic and clinical characteristics, perception about influenza, attitudes towards the role of influenza vaccine during COVID-19 pandemic and the factors that affect respondents' practice towards influenza vaccine.

RESULTS

73.1% population were not vaccinated, and most were not willing to be vaccinated during the COVID-19 pandemic. 55% of the population thought that influenza vaccine decreased the burden on the Jordanian healthcare system. The major refusal factor to be vaccinated was because influenza was not considered as a threat (41.3%). People mostly got their information about influenza vaccine from social media (64.3%). The role of the pharmacist and physician was neglected.

CONCLUSIONS

The reinforcement of the role of pharmacists, physician and media to educate people about the importance of influenza vaccine during the COVID-19 pandemic is needed. Furthermore, campaigns should be conducted to increase the population awareness towards the importance of influenza vaccine uptake and its importance.

Knowledge, attitude, and practice related to COVID-19: A comparison between patients with mental illness and the general population in Qatar

BACKGROUND

In 2020, the World Health Organization (WHO) declared COVID-19 a global health pandemic. The rapid spread and high fatalities associated with COVID-19 have increased interest in assessing Knowledge, Attitude, and Practice (KAP) toward this illness among the general population in comparison to specific subgroups. Most publications to date have explored KAP among the general public, healthcare providers, and people with chronic conditions, but not amongst those with mental illness. Yet, research has shown patients with mental illness are at higher risk of poor outcomes related to infectious diseases such as COVID-19. The objective of this study is to compare KAP toward COVID-19 between people with mental illness and the general public.

MATERIALS AND METHODS

This is a cross-sectional study, done over 3^°months in 2020, to compare KAP during the COVID-19 pandemic in three groups: outpatients from outpatient Psychiatry clinics (N = 165), inpatients admitted to a Psychiatry ward (N = 100), and the general public (N = 345). KAP parameters were assessed through online surveys.

RESULTS

The proportion of subjects in the public group (84.8%) giving the correct responses to most Knowledge questions was significantly higher than those in the inpatient and outpatient groups. Compared to the public and inpatient groups, subjects in the outpatient group (92.7%) were significantly more optimistic and confident that COVID-19 would be brought under control. A higher proportion of subjects from the general public (82.9%) indicated that they attended crowded places and were more compliant in wearing masks. Multiple linear regression analyses showed that poorer COVID-19 knowledge was associated with being single and having a young age (18-29), with both inpatients and outpatients and with primary-or secondary-level education.

CONCLUSION

Patient populations, both inpatients and outpatients, had inadequate Knowledge, more positive attitudes and confidence regarding the outcome of COVID-19, and less safe practices than the public. This highlights the need for targeted approaches around COVID-19 and pandemics in general in this vulnerable population.

The perceived need for evidence-based COVID-19 management and Tele-education in the North-East region of India: a cross-sectional survey

Due to the sudden rise in the cases of COVID-19 in the North-Eastern region of India, this study was conducted to survey the felt needs of the medical professionals with regards to education on the evidence-based management of COVID-19. A total of 25 North-East leaders were recruited and a baseline survey was conducted through the digital medium. Out of 25 North-East leaders, 52% were undergoing training in evidence-based medicine in the capacity-building program for evidence-based child health. Participants (48%) strongly agreed and 40% agreed on the possibility of enhanced care by capacity building in the areas of COVID-19 management through discussing cases. Out of 25 North East leaders, 48% agreed to join both as a speaker as well as a participant. Various priority topics on COVID-19 management e.g. childhood, adult, ocular manifestation, ICU management, telemedicine, vaccines, lab protocols, psychological distress, and treatment strategy have emerged. We have presented the findings of the survey which will help guide the mentoring program focusing on evidence-based management of COVID-19 in remote areas through Tele-education.

Prevalence and predictors of self-medication drugs to prevent or treat COVID-19: Experience from a Middle Eastern country

BACKGROUND

The lack of definitive cure for COVID-19 and the late introduction of a vaccine were responsible to push the general public to look for a remedy to treat or prevent COVID-19. The objective of this study was to evaluate patterns and factors that affect self-medication practices in Jordan during the pandemic.

METHODS

This was a cross-sectional study using an online questionnaire that was developed, piloted and distributed to the general public via various social media platforms. The questionnaire assessed the type of drugs and treatments used to self-medicate, the reasons behind their self-medication, and the factors affecting their practices.

RESULTS

A total of 1179 participants (females 46.4%) with a mean age of 32 (SD = 12.5) completed the questionnaire. The overall prevalence of the use of at least one product to treat or prevent COVID-19 was 80.4%. The most commonly used products to self-medicate were vitamin C (57.6%), followed by paracetamol (51.9%), zinc (44.8%) and vitamin D (32.5%). Female gender (odds ratio [OR]) = 1.603, working in the medical field (OR = 1.697), and history of COVID-19 infection (OR = 2.026) were variables associated with self-medication. The most common sources of participants' information about drugs to prevent or treat COVID-19 were newspapers (n = 519, 44.0%), followed by pharmacists (43.4%), friends (33.8%) and internet searching such as Google (30.7%).

CONCLUSION

This study identified the main drugs and supplements used during COVID-19 and the motives behind their use. It also identified the most influential source of information on the public during the pandemic. Self-medication can lead to worsening of the patient's health and delay seeking medical advice from healthcare professionals. Efforts should be done to help mitigate risks of self-medications by active involvement of pharmacists and other members of healthcare team to refute false claims about drug, especially in the media.

Analysis of change in knowledge, attitude, and practices about COVID-19 following and awareness session in rural population of Western India

BACKGROUND

Beginning of the pandemic showed our limitations in our understanding of the spread of the dreaded coronavirus-19 that had sprung from China and spread through thick and thin across the world. The measures to contain the spread of virus in the absence of specific treatment protocol had everyone grope for the solutions in a very short time frame. One such is the knowledge, attitude, and practice in the rural setup.

AIM

The aim of the study is to measure the change in knowledge, attitude, and practices (KAP) regarding COVID-19 following an awareness session in rural population.

MATERIALS AND METHODS

A cross-section interventional study was carried out in January 2021. An interactive awareness session was conducted with the help of audiovisual aids following MOHFW guidelines for COVID-19, and the change in KAP about COVID-19 was measured by pre- and posttest standardized questionnaire.

RESULTS

Of all the participants, statistically significant change in knowledge was seen from 43% to 52%. The villagers were educated about preventive steps and a positive change was measured in the practice of changing masks regularly (84%-100%), maintaining social distancing (44%-64%), frequent handwashing (52%-64%). No change was seen in wearing of masks (92%) and negative change was seen in avoiding handshakes (32%-28%). The preventive practices regarding COVID-19 pandemic changed significantly from 50% to 58%. Our study measured positive attitude change toward getting vaccinated from 64% to 72%.

CONCLUSION

A single, short awareness session led to significant change in KAP about COVID-19 in rural population.

Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis

OBJECTIVE

To assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19.

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed.

RESULTS

Out of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants' COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger's regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed.

CONCLUSIONS

This study's findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations.

PROSPERO REGISTRATION NUMBER

CRD42020203476.

COVID-19 Prevention Practices and Associated Factors Among Farmers in Peri-Urban Areas of Northeastern Ethiopia

BACKGROUND

COVID-19 is a global health threat due to its rapid spread and ability to kill millions of people. The majority of pandemic-fighting approaches rely on prevention activities, which can be influenced by a variety of factors. Farmers are more vulnerable to COVID-19, so evaluating existing prevention practices and associated factors is critical to prevent the COVID-19 pandemic.

OBJECTIVE

To assess COVID-19 prevention practices and associated factors among farmers in peri-urban areas of Northeastern Ethiopia.

METHODS

A community-based cross-sectional study design was conducted among 409 selected farmers. Data were collected using face-to-face interviews and on-the-spot-observational checklist. Data were analyzed using bivariable logistic regression model at 95% CI (confidence interval). During the bivariable analysis (crude odds ratio [COR]), varibales having a p-value of less than 0.250 were included into the multivariable analysis (adjsuted odds ratio [AOR]). Factors associated with COVID-19 preventive practices were determined using a multivariable analysis at a p-value of 0.050.

RESULTS

Of 409 participants, 206 (63.6%), 157 (38.4%), and 117 (28.6%) of them had satisfactory knowledge, positive attitude, and good prevention practices about COVID-19, respectively. Age of the farmers with greater than or equal to 45 years (AOR: 3.2; 95% CI: 1.7-6.1), educational status of secondary school and above (AOR: 3.1; 95% CI: 1.4-6.6), and income level of having greater than or equal to 2,001.00 Ethiopian birr (ETB) (AOR: 1.9; 95% CI: 1.1-3.4) were all found to be significantly associated with the COVID-19 prevention practices.

CONCLUSION

Even though the majority of farmers had satisfactory knowledge, a considerable proportion of them had a negative attitude and poor COVID-19 prevention practices. Age, educational status, and income level are factors associated with COVID-19 prevention practices. Hence, health education should be given to improve the farmers' knowledge, attitudes and prevention practices to minimize the risk of COVID-19 among farmers in semi-urban areas of northestern Ethiopia.

Willingness of Middle Eastern public to receive COVID-19 vaccines

Background

COVID-19 is a pacing pandemic that affected health systems, economy, and social life in the whole world. Currently, there is no treatment for it, but the world is in a race that yielded, in a relatively short time than usual, several approved, promising vaccines in the middle of a storm of debates because of the speed of their production and approval.

Objective

This study assessed the willingness of Middle Eastern Arab publics to receive COVID-19 vaccines and investigated the factors behind any reluctance to receive them.

Methods

A self-administered questionnaire was distributed through social media applications in four Arab countries (Jordan, Saudi Arabia, Lebanon, and Iraq). Participants’ demographics, medical history, their experience with COVID-19, and their willingness to receive the available vaccines were obtained and analyzed.

Results

A total of 2,925 completed forms were included. Only 25% of the participants were willing to receive a vaccine while 33% were hesitant. Iraqis were the most willing to receive it while Jordanians were the least (35% and 17% of each country, respectively). Interestingly, 60% of the acceptors were ready to pay for the vaccine if not covered by governments. It was also found that American vaccines were preffered by 50% of the acceptors. However, 30% of acceptors were unsure of which vaccine is the best and 11% stated that any vaccine is good. Social media were the major source of information about COVID-19 and its vaccines. Finally, predictors of acceptance of the vaccines included living in Saudi Arabia and Iraq, being unmarried, having monthly income > $1,000, holding a medical degree, having high fear from COVID-19, feeling of being at risk of getting infected with COVID-19, and previous reception of influenza vaccine, whereas predictors of refusal included female sex and previous infection with COVID-19.

Conclusion

Middle Eastern Arabs are less likely to accept receiving the COVID-19 vaccines compared with non-Arabs. Health authorities in these countries are advised to intensify their awareness-raising activities about the vaccines while ensuring fair distribution of them.

Awareness and perception of COVID-19 among the general population: A Middle Eastern survey

Due to the sudden emergence of the novel coronavirus as a worldwide pandemic, this study aimed to evaluate the awareness and practices of both the Jordanian and Iraqi populations during the early stages of the pandemic. A cross-sectional survey was conducted between the 19th and 22nd of March to assess the public's awareness toward COVID-19. Multiple scored domains were used to assess the differences between the two populations. Statistical analysis was conducted to reveal the influence of sociodemographic variables on these scores. A total of 3167 participants were recruited in the study, of which, 1599 (50.5%) were from Jordan and 1568 (49.5%) were from Iraq. More than half of the Jordanian (56.8%) and Iraqi participants (53.2%) showed average or adequate awareness about COVID-19. More than 60% of both populations relied on medical staff for COVID-19 related information. Social media was the second most common COVID-19 information source, as it was reported by 53.7% of Jordanian participants and 62.8% of Iraqi participants. More than 90% of both populations participated in precautionary measurements. Finally, about 20% of both populations failed to recognize droplet inhalation as a source of transmission. Despite the portrayed awareness levels, governmental involvement is warranted to increase the public's awareness and fill the gaps within their knowledge.

Knowledge, attitudes, and practices of the general population about Coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis with policy recommendations

Objectives

This study aimed to investigate and synthesize the current evidence on knowledge, attitudes, and practices (KAPs) of the general population regarding COVID-19.

Study design

This is a systematic review and meta-analysis.

Methods

We conducted a systematic search on PubMed/LitCovid, Scopus, and Web of Sciences databases for papers in the English language only, up to 1 January 2021. We used the Joanna Briggs Institute checklist developed for cross-sectional studies to appraise the quality of the included studies. All stages of the review conducted by two independent reviewers and potential discrepancies were solved with a consultation with a third reviewer. We reported the result as number and percentage. A meta-analysis conducted using a random effect model with a 95% confidence interval.

Results

Forty-eight studies encompassing 76,848 participants were included in this review. 56.53% of the participants were female. The mean age of the participants was 33.7 years. 85.42% of the included studies were scored as good quality, 12.50% as fair quality, and the remaining (2.08%) as low quality. About 87.5% examined all three components of the KAPs model. The knowledge component was reported as good and poor in 89.5% and 10.5% of the included studies, respectively. Of the studies that examined the attitude component, 100% reported a positive attitude. For the practice component, 93.2% reported satisfactory practice, and 6.8% poor practice. The result of the meta-analysis showed that the overall score of KAPs components about COVID-19 were 78.9, 79.8, and 74.1, respectively.

Conclusions

This systematic review and meta-analysis showed that the overall KAP components in the included studies were at an acceptable level. In general, knowledge was at a good level, the attitude was positive and practice was at a satisfactory level. Using an integrated international system can help better evaluate these components and compare them between countries.

PROSPERO registration code

(CRD42020186755).