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Article History

Received: 17 January 2025

Accepted: 13 March 2025

First Online: 27 March 2025

Declarations

:

: The European study protocol was approved by an ethics committee in each of the study countries. All countries had the support of their respective governments, including the ministries of education and health. Ethical approval was granted by the necessary authorities for each country. Furthermore, each country provided authorization from school authorities as follows: Bulgaria: The Deputy Minister of Education, Youth and Science of the Republic of Bulgaria; the Netherlands: The Commission of Faculty Ethical Behaviour Research; Italy: the ethical committee of the Association of European Mediterranean University. Parents received an information letter and a consent form to be signed and returned. Children who did not oppose study participation were included. In addition, child consent was obtained verbally. Data were anonymized. The Chinese survey was approved by the ethics committee of Tianjin Anding Hospital (Number 2019-01, date: Jan 9, 2019). Children could refuse at any time. Anonymity was preserved. Written informed consent to participate in this study was provided and signed.by the participants’ legal guardian/next of kin.

: The authors declare no competing interests.