Relevant bibliographies by topics / Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Myalgic Encephalomyelitis/Chronic Fatigue Syndrome'

Author: Grafiati
Published: 4 June 2021
Last updated: 16 February 2022

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Journal articles on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Carruthers, Bruce M., Anil Kumar Jain, Kenny L. De Meirleir, Daniel L. Peterson, Nancy G. Klimas, A. Martin Lerner, Alison C. Bested, et al. "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." Journal of Chronic Fatigue Syndrome 11, no. 1 (January 2003): 7–115. http://dx.doi.org/10.1300/j092v11n01_02.

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Jason, Leonard A., Abigail Brown, Erin Clyne, Lindsey Bartgis, Meredyth Evans, and Molly Brown. "Contrasting Case Definitions for Chronic Fatigue Syndrome, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Myalgic Encephalomyelitis." Evaluation & the Health Professions 35, no. 3 (December 7, 2011): 280–304. http://dx.doi.org/10.1177/0163278711424281.

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Burns, Dianne, Collette Bennett, and Amanda McGough. "Chronic fatigue syndrome or myalgic encephalomyelitis." Nursing Standard 26, no. 25 (February 22, 2012): 48–56. http://dx.doi.org/10.7748/ns2012.02.26.25.48.c8950.

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Colby, Jane. "Chronic fatigue syndrome and myalgic encephalomyelitis." Lancet 359, no. 9318 (May 2002): 1698. http://dx.doi.org/10.1016/s0140-6736(02)08575-6.

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Chaudhuri, Abhijit. "Chronic fatigue syndrome and myalgic encephalomyelitis." Lancet 359, no. 9318 (May 2002): 1698–99. http://dx.doi.org/10.1016/s0140-6736(02)08576-8.

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Prins, Judith B., Gijs Bleijenberg, and Jos WM van der Meer. "Chronic fatigue syndrome and myalgic encephalomyelitis." Lancet 359, no. 9318 (May 2002): 1699. http://dx.doi.org/10.1016/s0140-6736(02)08577-x.

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Jason, Leonard, Kristen Barker, and Abigail Brown. "Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." Reviews in Health Care 3, no. 4 (October 12, 2012): 257. http://dx.doi.org/10.7175/rhc.28034257-270.

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Research on pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is reviewed in this article. Many recent articles in this area highlight the existence of key differences between the adult and pediatric forms of the illness. This review article provides an overview of pediatric ME/ CFS, including epidemiology, diagnostic criteria, treatment, and prognosis. Challenges to the field are identified with the hope that in the future pediatric cases of ME/CFS can be more accurately diagnosed and successfully managed.
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Jason, Leonard, Kristen Barker, and Abigail Brown. "Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." Reviews in Health Care 3, no. 4 (October 12, 2012): 257–70. http://dx.doi.org/10.7175/rhc.v3i4.280.

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Research on pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is reviewed in this article. Many recent articles in this area highlight the existence of key differences between the adult and pediatric forms of the illness. This review article provides an overview of pediatric ME/ CFS, including epidemiology, diagnostic criteria, treatment, and prognosis. Challenges to the field are identified with the hope that in the future pediatric cases of ME/CFS can be more accurately diagnosed and successfully managed.
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White, Peter, Maurice Murphy, Jill Moss, George Armstrong, and Sir Peter Spencer. "Chronic fatigue syndrome or myalgic encephalomyelitis." BMJ 335, no. 7617 (August 30, 2007): 411–12. http://dx.doi.org/10.1136/bmj.39316.472361.80.

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Burns, Dianne, Amanda McGough, and Collette Bennett. "Chronic fatigue syndrome or myalgic encephalomyelitis." Nursing Standard 26, no. 25 (February 22, 2012): 48–56. http://dx.doi.org/10.7748/ns.26.25.48.s51.

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Dissertations / Theses on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Goudsmit, Ellen Marianne. "The psychological aspects and management of chronic fatigue syndrome." Thesis, Brunel University, 1996. http://bura.brunel.ac.uk/handle/2438/4283.

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Chronic fatigue syndrome (CFS) describes a condition characterised by severe fatigue of at least six months' duration. In this thesis, it is argued that the complexity of CFS with respect to other symptoms, the patients' response to their illness and the determinants of emotional distress, has yet to be fully recognised. This may have narrowed the focus of research and limited the range of treatments available. The first of the three studies investigated CFS from the patients' perspective. The findings challenge some of the generalisations concerning CFS, particularly those relating to the patients' attributions and their choice of coping strategies. They also suggest that the effects of the condition may have been underestimated and that certain influences on emotional distress may have been overlooked. The second study assessed a number of variables thought to be associated with emotional distress and psychological adjustment. The results show that uncertainty and lack of social support were significantly correlated with anxiety and depression while functional impairment was more closely linked to cognitive difficulties and other illness-related measures. The third study evaluated a management programme which acknowledges the complexity of CFS. After six months, significant differences between the treated patients and waiting-list controls were found for a number of variables, including fatigue, somatic symptoms, anxiety and perceived self-efficacy. However, many patients continued to record high levels of emotional distress, showing that the programme was not sufficient to deal with all the problems experienced.
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Lynch, Sean Patrick Jeremy. "The nature of fatigue in the chronic fatigue syndrome : a longitudinal study." Thesis, Imperial College London, 1996. http://hdl.handle.net/10044/1/7496.

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Ramsden, Rebecca Mary. "Narratives of partners of individuals affected by Chronic Fatigue Syndrome/Myalgic Encephalomyelitis." Thesis, University of Hertfordshire, 2016. http://hdl.handle.net/2299/17195.

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Background and Aims: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) remains a poorly understood condition, shrouded in uncertainty and dispute. Research suggests this context to have a profound bearing on those touched by the condition, impacting significantly on their experience and the narratives constructed thereof. However, no studies examining the narratives of partners of individuals affected by CFS/ME appear to have been carried out to date. Based upon this gap in the literature, this study sought to hear the narratives of partners of adults living with CFS/ME, giving particular consideration to the ways in which these narratives were told to an outsider, and how the outsider may have influenced the narrative. Methodology: This study drew on a qualitative approach. A purposive sample of six partners of adults affected by CFS/ME (4 men and 2 women) was recruited. Individual interviews were conducted that were audio-recorded and transcribed. Narrative analysis was used to analyse the transcripts, focusing principally on how participants narrated their accounts, as well as on the content of narratives and the narrative and discursive features that shaped the telling of the accounts. Analysis and Findings: Multiple readings of the narratives identified two areas of collective focus within participants' accounts - 'stories from then' and 'stories from now'. Some similarities in how 'stories from now' were told were seen to emerge down gender lines. Notably participants' storytelling could be seen to represent a form of response to wider narratives that purvey around CFS/ME, with participants' being observed to construct particular meanings around CFS/ME, as well as particular 'identities' of themselves, their partner, their relationship and 'others' who had played a key role in their story of living with the condition. The findings are discussed in terms of their potential bearing for clinical practice and future research endeavours. In addition, the strengths and the limitations of the research are considered.
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Barcroft, Rachel. "Chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia : a social model of disability perspective." Thesis, Lancaster University, 2017. http://eprints.lancs.ac.uk/87165/.

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This thesis is composed firstly of a literature review focusing on the attitudes of health professionals towards chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia. Secondly, a research paper explores the ways in which people living with CFS/ME have experienced psycho-emotional disablism. Finally, a critical appraisal discusses the process of conducting the research as well as its strengths and limitations. The literature review takes the form of a meta-synthesis regarding the attitudes of healthcare professionals towards CFS/ME and fibromyalgia. A meta-ethnographic approach was used with reciprocal translation producing the following themes: “Feeling hopeless and more hopeless”: psychological effects of lack of knowledge; “Your heart sinks when they come in the room”: stigma and stereotypes; and “I’m going to be with you through thick and thin”: management of the condition. The review highlights the difficulties faced by health professionals regarding the management and diagnosis of both conditions, as well as possible reasons for the negative attitudes held by some professionals. The research paper, which employed thematic analysis, explores the ways in which people living with CFS/ME have experienced psycho-emotional disablism. Three overarching themes were identified: “fighting to be heard”; “lack of legitimacy” and “feeling invisible”. Participants described the discrimination and stigma that they had encountered from many areas of society. Ideas for future research are proposed. The critical appraisal presents the author’s reflections on the research process as well as its strengths and limitations, and the five stages of the process are described as follows: choosing a thesis topic and designing the project; recruitment and research interviews; the interview process; analysis and writing up of the data; and the author’s reflections on the project.
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Payne, Rosalind. "Narratives of parents living with a child affected by chronic fatigue syndrome/myalgic encephalomyelitis." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/17472.

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Background and Aims: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) remains a poorly understood condition, shrouded by debate, stigma, and uncertainty. Unsurprisingly, the little available research suggests that caring for a Child or Young Person (CYP) affected by the condition can be extremely challenging. While the majority of available literature is quantitative in nature, there is some qualitative research examining the impact of having a CYP with CFS/ME on parents. However, there currently appear to be no studies examining the narratives of parents living with a CYP with CFS/ME. Therefore, this research aimed to hear how parents narrate their experiences of living with a CYP affected by CFS/ME, paying attention to how they construct their identity, and the contested condition. Methodology: This research drew on a qualitative approach that explored the narratives of the participants. A purposive sample of five parents of CYP affected by CFS/ME (5 mothers) was recruited for a single semi-structured interview. The interviews were audio-recorded, transcribed, and analysed using a narrative approach to explore what participants said and how they narrated their accounts. This was then situated within the social and cultural contexts that shaped them. Analysis and Findings: Multiple readings of the narratives allowed me to develop a summary of each individual's narrative account. These were presented, after which similarities and differences across narratives were considered. Analysis identified six areas of collective focus: 'stories of onset and diagnosis', 'stories of battle', 'stories of finding the person/people who can help', 'stories of impact', 'stories of seeking social support', and 'stories of coping and adjustment'. Participants' narratives were heavily influenced by dominant societal discourses surrounding CFS/ME and motherhood, and could be seen as a response to these narratives. Consequently, participants offered particular constructions of the condition, themselves, their CYP, and others that they had come into contact with. These findings are discussed with reference to their potential bearing for clinical practice, strengths and limitations of the methodology, and directions for future research.
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McKay, Pamela Gair. "An exploratory study into the symptoms of chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia." Thesis, University of the West of Scotland, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.738487.

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Stalmeisters, Dzintra. "An investigation into the relationship between early maladaptive schemas and myalgic encephalomyelitis/chronic fatigue syndrome." Thesis, University of Derby, 2012. http://hdl.handle.net/10545/312811.

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The aim of the research was to investigate the relationship between early maladaptive schemas, as described by Young, Klosko and Weishaar (2003), and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Despite the recognition of characteristics associated with these schemas in people with ME/CFS by clinicians, a review of the literature suggests that systematic research into this relationship has not previously been conducted. This thesis progresses knowledge in this area by providing a schema-level understanding of ME/CFS and offering insights into the behavioural process involved in the progression from schema to illness. The research employed mixed methods enabling a consideration of the relationship from different perspectives, and is grounded in a critical realist perspective. The quantitative study involved 40 people with ME/CFS and 40 people from a non- clinical population who completed Young's Schema Questionnaire (YSQ-S3), a questionnaire designed to elicit 18 early maladaptive schemas. The schemas Unrelenting Standards and Self-Sacrifice were the most prevalent in both groups. Unrelenting Standards was endorsed by 47.5% of the ME/CFS group and by 25% of the non-clinical group at a level of' clinical caseness', whilst the percentage of people that endorsed the Self-Sacrifice schema was similar in each group; 27.5% of the ME/CFS group endorsed this schema and 25% of the non-clinical group. There were significant correlations between the schemas Unrelenting Standards and Self- Sacrifice; age and the schema Social Isolation; qualifications and the schema Self- Sacrifice also current employment and the schema Unrelenting Standards. The qualitative study, which involved 13 people with ME/CFS, adopted a Grounded Theory approach influenced mainly by the works of Glaser, (1978, 1998, 2011) and Charmaz (1995, 2007). The core category generated from the data was termed 'obscuring', and conceptualised the manner in which early maladaptive schemas and the coping style 'surrender to the schema' obscured the needs of individuals with throughout the therapeutic process. The number of early maladaptive schemas reduced once depression had been treated, whilst the schemas Unrelenting Standards and Self-sacrifice remained at a level of 'clinical caseness' at the end of therapy, although their scores on Young et al. 's Schema Questionnaire (YSQ S-3) had decreased. The qualitative study and case study gave an insight into the complexity of early maladaptive schemas in relation to the illness, giving real life meaning to the quantitative findings and together the three studies increased the credibility of the theory that emerged from the qualitative analysis. Taken together the studies have implications for the Cognitive Behavioural model of ME/CFS (Surawy et al. 1995). It is proposed that early maladaptive schemas have relevance for the model at the predisposing and perpetuating levels; that the theoretical codes 'compelling', 'curtailing' and 'compassionating', derived from the grounded theory analysis, are evident at these levels; and that the model might benefit from the inclusion of the terms 'unhelpful emotional responses' and 'psychological rewards'. The research not only supports clinical observations, but also contributes to cognitive and behavioural theory and therapeutic interventions for ME/CFS, helping to deepen understanding of the role that early maladaptive schemas have in this disabling and unpredictable illness. Recommendations are made for clinical practice and future research.
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Osoba, Tolu. "The development of an epidemiological case definition for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)." Thesis, University of the West of England, Bristol, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.444489.

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Whitehead, Lisa. "The lived experience of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) : sufferers' and families' perspectives." Thesis, University of Liverpool, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406661.

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Williams, Deborah Samantha. "Long-term experiences of managing Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) : a qualitative study." Thesis, University of the West of England, Bristol, 2016. http://eprints.uwe.ac.uk/28310/.

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Background: Frustrations are noted in the management of CFS/ME as it’s a complex and individual condition with no known cure. Despite being a Long-term Condition (LTC) limited research has focused on long-term experiences. This study aims to extend the knowledge of long-term experiences of CFS/ME specifically focusing on management of the condition. Thinking about therapeutic moderators and mechanisms of change, whether management changes throughout the course of the illness and what support people might benefit from. Methods: A qualitative research design, using semi-structured interviews was adopted. Nine participants' were recruited from a specialist CFS/ME Service in the UK who were over 18 years old, had a diagnosis of CFS/ME and reported experiencing fatigue related symptoms for over 5 years. Interviews were audio recorded, transcribed verbatim and analysed using Thematic Analysis. Findings: Three themes; Awareness, Acceptance, Connection and two subthemes; connection with self and connection with others were constructed from the data. An overarching theme of Awareness appeared to facilitate the ability to accept and connect with what was important for people with CFS/ME, enabling people to adapt to living with the condition and achieving a standard of living. Commonalities occurred across all themes of development over time, individuality and ongoing balance or monitoring. Discussion: Findings suggest supporting adults with CFS/ME to become more self-aware of their illness experience and identifying their values will be beneficial at any stage of the illness duration, but particularly important for long-term management. These findings provide further support for tailored treatment plans (NICE, 2007) with some individuals' needing more, or occasional contact with understanding professionals to achieve. The results support the use of acceptance-based interventions in LTC management; specifically Acceptance and Commitment Therapy (ACT) and Focused ACT. Further research into outcomes and experiences of ACT in CFS/ME, and interdisciplinary approaches is advocated.
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Books on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Great Britain. Department of Health. Chronic fatigue syndrome/myalgic encephalopathy (CFS/ME). London: Department of Health, 2004.

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Dr, Murphy Gabrielle, ed. Coping better with chronic fatigue syndrome/myalgic encephalomyelitis: Cognitive behaviour therapy for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ ME). London: Karnac Books, 2009.

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(undifferentiated), David G. Smith. Understanding M.E. London: Constable, 1992.

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Smith, David G. Understanding M.E.: The phenomenon of myalgic encephalomyelitis and acute onset post viral fatigue syndrome. London: Robinson Publishing, 1991.

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Understanding M.E.: The phenomenon of myalgic encephalomyelitis and acute onset post viral fatigue syndrome. London: Constable, 1989.

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Smith, David G. Understanding M.E.: The phenomenon of myalgic encephalomyelitis and acute onset post viral fatigue syndrome. London: Robinson Publishing, 1989.

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ME: Chronic fatigue syndrome : how to live with it. London: Thorsons, 1998.

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Bell, David S. Neuro-immune fatigue ME/CFS/FM and cellular hypoxia. Livermore, CA: WingSpan Press, 2007.

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Shepherd, Charles. Living with M.E. London: Cedar, 1989.

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Shepherd, Charles. Living with M. E. London: Cedar, 1990.

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Book chapters on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Costa, D. C., and A. Greco. "Chronic Fatigue Syndrome/Myalgic Encephalomyelitis." In Nuclear Medicine in Psychiatry, 289–300. Berlin, Heidelberg: Springer Berlin Heidelberg, 2004. http://dx.doi.org/10.1007/978-3-642-18773-5_17.

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Sarzi-Puttini, Piercarlo, Alberto Batticciotto, Rossella Talotta, and Fabiola Atzeni. "Differential Diagnosis of Vasovagal Syncope: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." In Vasovagal Syncope, 197–211. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-09102-0_16.

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Wicks, Sally. "Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis in Children and Young People." In Child and Adolescent Mental Health, 366–73. 3rd ed. Third edition. | New York, NY: Routledge, 2021.: CRC Press, 2021. http://dx.doi.org/10.4324/9781003083139-55.

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Wallis, Amy, Melinda L. Jackson, Michelle Ball, Donald P. Lewis, and Dorothy Bruck. "Sleep, Cognitive and Mood Symptoms in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." In The Handbook of Stress and Health, 501–22. Chichester, UK: John Wiley & Sons, Ltd, 2017. http://dx.doi.org/10.1002/9781118993811.ch31.

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Glaudemans, Andor W. J. M. "PET and SPECT Studies in the Chronic Fatigue Syndrome/Myalgic Encephalomyelitis." In PET and SPECT in Psychiatry, 743–58. Berlin, Heidelberg: Springer Berlin Heidelberg, 2014. http://dx.doi.org/10.1007/978-3-642-40384-2_33.

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Watanabe, Yasuyoshi. "PET/SPECT/MRI/fMRI Studies in the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." In PET and SPECT in Psychiatry, 985–1001. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-57231-0_32.

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Löfgren, Monika, Marie-Louise Schult, Ann Öhman, Per Julin, and Jan Ekholm. "Fibromyalgia Syndrome or Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Factors Influencing Work Disability in Women." In Handbooks in Health, Work, and Disability, 459–80. Boston, MA: Springer US, 2016. http://dx.doi.org/10.1007/978-1-4899-7627-7_26.

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Maes, Michael. "Inflammatory and Oxidative and Nitrosative Stress Cascades as New Drug Targets in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome." In Inflammation in Psychiatry, 162–74. Basel: S. KARGER AG, 2013. http://dx.doi.org/10.1159/000343982.

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Foster, Caroline, and Jennifer McIntosh. "Chronic fatigue syndrome/myalgic encephalopathy." In Dietetic and Nutrition Case Studies, 78–80. Chichester, UK: John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119163411.ch20.

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Adkins, Julie, Jill C. Cash, Beverly R. Byram, Cheryl A. Glass, Kristin Ownby, and Pat Obulaney. "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." In Adult-Gerontology Practice Guidelines. New York, NY: Springer Publishing Company, 2019. http://dx.doi.org/10.1891/9780826159311.0020e.

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Conference papers on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Domingues, Tiago Dias, Helena Mouriño, and Nuno Sepúlveda. "A statistical analysis of serological data from the UK myalgic encephalomyelitis/chronic fatigue syndrome biobank." In INTERNATIONAL CONFERENCE OF NUMERICAL ANALYSIS AND APPLIED MATHEMATICS ICNAAM 2019. AIP Publishing, 2020. http://dx.doi.org/10.1063/5.0026633.

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Neale, FK, TY Segal, and DS Hargreaves. "G13 Prevalence and correlates of low mood, poor quality of life and high symptom impact in adolescents attending a tertiary service for chronic fatigue syndrome/myalgic encephalomyelitis." In Royal College of Paediatrics and Child Health, Abstracts of the Annual Conference, 13–15 March 2018, SEC, Glasgow, Children First – Ethics, Morality and Advocacy in Childhood, The Journal of the Royal College of Paediatrics and Child Health. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2018. http://dx.doi.org/10.1136/archdischild-2018-rcpch.13.

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Ayadi O’Donnell, N., A. McCourt, and T. Segal. "G531(P) A cohort study of whether parental separation and lack of contact with a parent predicts disease severity at diagnosis in young peoples chronic fatigue syndrome/myalgic encephalomyelitis." In Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference–Online, 25 September 2020–13 November 2020. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2020. http://dx.doi.org/10.1136/archdischild-2020-rcpch.449.

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Taylor, AM, J. Man, EJ Parish, and T. Segal. "G18(P) Our chronic fatigue syndrome/encephalomyelitis service is nice, but is it patient friendly? experience of going beyond audit." In Royal College of Paediatrics and Child Health, Abstracts of the Annual Conference, 13–15 March 2018, SEC, Glasgow, Children First – Ethics, Morality and Advocacy in Childhood, The Journal of the Royal College of Paediatrics and Child Health. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2018. http://dx.doi.org/10.1136/archdischild-2018-rcpch.17.

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Reports on the topic "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"

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Smith, M. E. Beth, Heidi D. Nelson, Elizabeth Haney, Miranda Pappas, Monica Daeges, Ngoc Wasson, and Marian McDonagh. Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Agency for Healthcare Research and Quality, December 2014. http://dx.doi.org/10.23970/ahrqepcerta219.

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