Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS.

The COVID-19 pandemic forced many higher education institutions (HEIs) across the world to cancel face-to-face teaching, close campus facilities, and displace staff and students to work and learn from home. Given the persistent nature of the pandemic, many HEIs have continued to deliver courses online and/or use a blended learning approach. However, there are concerns around differences in student access to digital learning resources while at home, including high quality broadband connectivity. This is important, since variation in connectivity may impact the type of online/blended model that faculty can deliver or constrain student engagement with online content. In this context, this paper combines national data on the domiciles of students enrolled in Irish HEIs with detailed spatial data on broadband coverage to estimate the number of higher education students ‘at risk’ of poor access to high quality internet connectivity. Overall it finds that one-in-six students come from areas with poor broadband coverage, with large disparities by geography and by HEI. It also finds that students from the poorest broadband coverage areas are more likely to be socioeconomically disadvantaged. As a result, this paper recommends that HEIs use their detailed registration data to help identify and support at-risk students. In particular, the results suggest that some HEIs may need to prioritise access to campus facilities and services to less well-off students living in poor broadband coverage areas.

The objective of this paper is to quantify and decompose the socioeconomic gradient in childhood obesity in the Republic of Ireland. The analysis is performed using data from the first wave of the Growing Up in Ireland survey, a nationally representative survey of 8568 nine-year-old children conducted in 2007 and 2008. We estimate concentration indices to quantify the extent of the socioeconomic gradient in childhood obesity and undertake a subsequent decomposition analysis to pinpoint the key factors underpinning the observed inequalities. Overall the results confirm a strong socioeconomic gradient in childhood obesity in the Republic of Ireland. Concentration indices of obesity (CI=-0.168) and overweight/obese (CI=-0.057) show that the gradient is more pronounced in obese children, while results from the decomposition analysis suggest that the majority of the inequality in childhood obesity is explained by parental level variables. Our findings suggest that addressing childhood obesity inequalities requires coordinated policy responses at both the child and parental level.

Numerous extension efforts promote climate smart agriculture (CSA) in Sub-Saharan Africa. The need to focus on gender disparity within CSA is widely understood. Given the prominence of female agriculturalists in Malawi, such focus can make a large impact on the country's rural sustainable development. This study quantifies the impact of extension techniques, including lead farmers, NGO trainers, and farmer clubs, on men and women farmers in Malawi by applying ordered logistic regression to data concerning post-extension increases in self-assessed CSA knowledge. Male and female farmers achieved increases in knowledge through traditional extension (NGO trainers and farmer clubs). However, these gains were less for female farmers. The interaction of female farmers with lead farmers (i.e. community members trained to train others) made increases in knowledge more likely. The impact of lead farmers was lessened by limited mobility and availability. Based on the study findings, we advocate for innovative approaches to CSA extension that aim to increase understanding of differing needs and preferences of female farmers. A failure to include women farmers in design from the outset misses a key opportunity to develop understanding of related societal challenges, increasing the likelihood of nominal participation and uneven outcomes among participating farmers.

We have developed a Europe-wide approach to investigating the economic impact of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), facilitating acquisition of information on the economic burden of ME/CFS, and international comparisons of economic costs between countries. The economic burden of ME/CFS in Europe appears large, with productivity losses most significant, giving scope for substantial savings through effective prevention and treatment. However, economic studies of ME/CFS, including cost-of-illness analyses and economic evaluations of interventions, are problematic due to different, arbitrary case definitions, and unwillingness of doctors to diagnose it. We therefore lack accurate incidence and prevalence data, with no obvious way to estimate costs incurred by undiagnosed patients. Other problems include, as for other conditions, difficulties estimating direct and indirect costs incurred by healthcare systems, patients and families, and heterogeneous healthcare systems and patterns of economic development across countries. We have made recommendations, including use of the Fukuda (CDC-1994) case definition and Canadian Consensus Criteria (CCC), a pan-European common symptom checklist, and implementation of prevalence-based cost-of-illness studies in different countries using an agreed data list. We recommend using purchasing power parities (PPP) to facilitate international comparisons, and EuroQol-5D as a generic measure of health status and multi-attribute utility instrument to inform future economic evaluations in ME/CFS.

Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.