BACKGROUND: Neurologists refer to numerous \"syndromes,\" consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative \"diseases,\" on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage.
METHODS: We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic.
CONCLUSIONS: Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new \"diseases\" should be defined and adapted to current knowledge and practice.

The study of the human microbiome has led to an exceptional increase in the current understanding of the importance of microbiota for health throughout all stages of life. Human microbial colonization occurs in the skin, genitourinary system and, mainly, in the oral cavity and intestinal tract. In these locations, the human microbiota establishes a symbiotic relationship with the host and helps maintain physiological homeostasis. Lifestyle, age, diet and use of antibiotics are the main regulators of the composition and functionality of human microbiota. Recent studies have indicated the reduction in microbial diversity as one of the contributors to the development of diseases. In addition to phylogenetic diversity studies, further metagenomic studies are needed at the functional level of the human microbiome to improve our understanding of its involvement in human health.

Assessing the scope and severity of threats is necessary for evaluating impacts on populations to inform conservation planning. Quantitative threat assessment often requires monitoring programs that provide reliable data over relevant spatial and temporal scales, yet such programs can be difficult to justify until there is an apparent stressor. Leveraging efforts of wildlife management agencies to record winter counts of hibernating bats, we collated data for 5 species from over 200 sites across 27 U.S. states and 2 Canadian provinces from 1995 to 2018 to determine the impact of white-nose syndrome (WNS), a deadly disease of hibernating bats. We estimated declines of winter counts of bat colonies at sites where the invasive fungus that causes WNS (Pseudogymnoascus destructans) had been detected to assess the threat impact of WNS. Three species undergoing species status assessment by the U.S. Fish and Wildlife Service (Myotis septentrionalis, Myotis lucifugus, and Perimyotis subflavus) declined by more than 90%, which warrants classifying the severity of the WNS threat as extreme based on criteria used by NatureServe. The scope of the WNS threat as defined by NatureServe criteria was large (36% of Myotis lucifugus range) to pervasive (79% of Myotis septentrionalis range) for these species. Declines for 2 other species (Myotis sodalis and Eptesicus fuscus) were less severe but still qualified as moderate to serious based on NatureServe criteria. Data-sharing across jurisdictions provided a comprehensive evaluation of scope and severity of the threat of WNS and indicated regional differences that can inform response efforts at international, national, and state or provincial jurisdictions. We assessed the threat impact of an emerging infectious disease by uniting monitoring efforts across jurisdictional boundaries and demonstrated the importance of coordinated monitoring programs, such as the North American Bat Monitoring Program (NABat), for data-driven conservation assessments and planning.
Alcance y Severidad del Síndrome de Nariz Blanca en los Murciélagos Hibernando en América del Norte Resumen La evaluación del alcance y la severidad de las amenazas es necesaria para los análisis de impacto sobre las poblaciones que se usan para orientar a la planeación de la conservación. La evaluación cuantitativa de amenazas con frecuencia requiere de programas de monitoreo que proporcionen datos confiables en escalas espaciales y temporales, aunque dichos programas pueden ser difíciles de justificar hasta que exista un estresante aparente. Gracias a una movilización de esfuerzos de las agencias de manejo de fauna para registrar los conteos invernales de murciélagos hibernadores, recopilamos datos para cinco especies en más de 200 sitios a lo largos de 27 estados de EUA y dos provincias canadienses entre 1995 y 2018 para determinar el impacto del síndrome de nariz blanca (SNB), una enfermedad mortal de los murciélagos hibernadores. Estimamos declinaciones en los conteos invernales de las colonias de murciélagos en sitios en donde el hongo invasivo que ocasiona el SNB (Pseudogymnoascus destructans) había sido detectado para evaluar el impacto de amenaza del SNB. Tres especies que se encuentran bajo valoración por parte del Servicio de Pesca y Vida Silvestre de los EUA (Myotis septentrionalis, Myotis lucifugus y Perimyotis subflavus) tuvieron una declinación de más del 90%, lo que justifica la clasificación de la severidad de la amenaza del SNB como extrema con base en el criterio usado por NatureServe. El alcance de la amenaza del SNB definido por el criterio de NatureServe fue desde amplio (36% de la distribución de Myotis lucifugus) hasta dominante (79% de la distribución de Myotis septentrionalis) para estas especies. Las declinaciones de otras dos especies (Myotis sodalis y Eptesicus fuscus) fueron menos severas, pero de igual manera quedaron clasificadas desde moderada hasta seria con base en los criterios de NatureServe. El intercambio de datos entre las jurisdicciones proporcionó una evaluación completa del alcance y la severidad de la amenaza del SNB e indicó las diferencias regionales que pueden guiar a los esfuerzos de respuesta realizados en las jurisdicciones internacionales, nacionales, estatales o provinciales. Evaluamos el impacto de amenaza de una enfermedad infecciosa emergente mediante la combinación de los esfuerzos de monitoreo que sobrepasan fronteras jurisdiccionales y demostramos la importancia que tienen para la planeación y la evaluación basadas en datos de la conservación los programas de monitoreo coordinados, como el Programa de Monitoreo de los Murciélagos Norteamericanos (NABat).

As shown in our previous paper (\'Regression I. Experimental approaches to regression\', JAP, 65, 2, 345-65), the common mechanism of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the proportion of low-differentiated (older) systems in actualized experience. Experimental data show that regression following disease (chronic tension headache) is followed by adaptation and an increase in system differentiation in that experience domain which contains systems responsible for that adaptation. The results of mathematical modelling support the idea that reversible dedifferentiation can be one of the mechanisms for increasing the effectiveness of adaptation through learning. Reversible dedifferentiation, which is phenomenologically described as regression, is a general mechanism for restructuring the organism-environment interactions in situations where behaviours that were effective in the past become ineffective. Reversible dedifferentiation has evolved as a component of adaptation when new behaviours are formed and large-scale modifications in the existing behaviours are required in the face of changes in the external and/or internal environment. Thus, the authors believe that this article provides evidence for Jung\'s view that regression is not only a \'return\' to past forms of thinking, affects and behaviour, but that regressive processes provide a significant impetus for psychological growth and development.
Comme nous l’avons montré dans notre article précédent (« Régression I. Les approches expérimentales de la régression »), le mécanisme propre à la régression peut être décrit en tant que dé-différentiation réversible, ce que l’on peut comprendre comme une hausse relative de la proportion de systèmes peu différentiés (plus vieux) dans l’expérience actualisée. Les données expérimentales montrent que la régression suite à une maladie (mal de tête de tension chronique) est suivie par une adaptation et un accroissement dans la différentiation des systèmes dans le domaine d’expérience qui contient les systèmes responsables de cette adaptation. Les résultats de la modélisation mathématique soutiennent l’idée que la dé-différentiation réversible peut être l’un des mécanismes pour accroitre l’efficacité de l’adaptation par l’apprentissage. La dé-différentiation réversible, qui est décrite phénoménologiquement comme régression, est un mécanisme général pour restructurer les interactions organisme-environnement dans des situations où les comportements qui fonctionnaient par le passé sont devenus inefficaces. La dé-différentiation réversible a évolué comme un élément de l’adaptation quand de nouveaux comportements se développent et que des changements dans l’environnement extérieur ou intérieur requièrent des modifications à grande échelle dans les comportements existants. Ainsi, les auteurs pensent que cet article apporte un soutien à la perspective de Jung selon laquelle la régression n’est pas seulement un « retour » à des formes anciennes de fonctionnement, d’affects et de comportement, mais que les processus régressifs fournissent un élan significatif pour la croissance et le développement psychologiques.
Wie wir in unserem vorangegangenen Artikel gezeigt haben (‘Regression I. Experimentelle Ansätze zur Regression’), kann der gewöhnliche Regressionsmechanismus als reversible Entdifferenzierung beschrieben werden, die als relative Zunahme des Anteils niedrig differenzierter (älterer) Systeme innerhalb aktualisierten Erlebens verstanden wird. Experimentelle Daten zeigen, daß auf die nach einer Krankheit (chronischer Spannungskopfschmerz) auftretende Regression eine Anpassung und eine Zunahme der Systemdifferenzierung in jenem Erfahrungsbereich folgt, der Systeme enthält, die für diese Anpassung verantwortlich sind. Die mit Hilfe eines mathematischen Modells gewonnenen Ergebnisse stützen die Idee, daß reversible Entdifferenzierung einer der Mechanismen zur Steigerung der Wirksamkeit der Anpassung durch Lernen sein kann. Reversible Entdifferenzierung, die phänomenologisch als Regression bezeichnet wird, ist ein allgemeiner Mechanismus zur Restrukturierung der Wechselwirkungen zwischen Organismus und Umwelt in Situationen, in denen Verhaltensweisen, die in der Vergangenheit wirksam waren, unwirksam werden. Reversible Entdifferenzierung hat sich als Bestandteil der Anpassung entwickelt, wenn neue Verhaltensweisen gebildet werden und umfangreiche Änderungen an den vorhandenen Verhaltensweisen angesichts von Änderungen in der externen und/oder internen Umgebung erforderlich sind. Die Autoren gehen daher davon aus, daß dieser Artikel die Ansicht von Jung belegt, daß Regression nicht nur eine \'Rückkehr\' zu früheren Formen des Denkens, von Affekten und Verhalten ist, sondern daß regressive Prozesse einen signifikanten Impuls für psychologisches Wachstum und Entwicklung liefern.
Come abbiamo mostrato nel nostro precedente articolo (\'Regressione I. Approcci sperimentali alla regressione\'), il comune meccanismo di regressione può essere descritto come una de-differenziazione reversibile, che è intesa come un aumento dei sistemi poco differenziati (vecchi) nell\'esperienza concreta. I dati sperimentali mostrano che la regressione successiva ad un disturbo (come il mal di testa da tensione cronica) è seguita dall\'adattamento e da un aumento della differenziazione del sistema in quel settore di esperienza che contiene i sistemi responsabili di tale adattamento. I risultati della modellazione matematica supportano l\'idea che la de-differenziazione reversibile possa essere uno dei meccanismi che aumentano l\'efficacia dell\'adattamento attraverso l\'apprendimento. La de-differenziazione reversibile, che è fenomenologicamente descritta come regressione, è un meccanismo generale per la riorganizzazione delle interazioni organismo-ambiente in situazioni in cui comportamenti che erano efficaci in passato diventano inefficaci. La de-differenziazione reversibile si è evoluta in una componente dell’adattamento rispetto a nuovi comportamenti o modifiche su larga scala nei comportamenti esistenti, a fronte di cambiamenti nell\'ambiente esterno e/o interno. Pertanto, gli Autori ritengono che questo articolo offra sostegno all’idea di Jung secondo cui la regressione non è solo un “ritorno” a forme passate di pensiero, affetti e comportamento, ma fornisca anche un impulso significativo per la crescita e lo sviluppo psicologico.
Как мы показали в нашей предыдущей статье («Регрессия I. Экспериментальные подходы к регрессии»), общий механизм регрессии можно описать как обратимую дедифференциацию, которая понимается как относительное увеличение доли низкодифференцированных (более старых) систем в актуализированном опыте. Экспериментальные данные показывают, что возникающая после заболевания (например, после хронической головной боли напряжения) регрессия сопровождается адаптацией и увеличением системной дифференциации в то м домене опыта, которыйсодержит системы, ответственные за эту адаптацию. Результаты математического моделирования подтверждают идею о том, что обратимая дедифференциация может быть одним из механизмов повышения эффективности адаптации посредством обучения. Обратимая дедифференциация, которая феноменологически описывается как регрессия, является общим механизмом реструктуризации взаимодействий организм-среда в ситуациях, когда поведение, которое было эффективным в прошлом, становится неэффективным. Обратимая дедифференциация развивается как компонент адаптации, когда формируется новое поведение и требуются крупномасштабные изменения в существующем поведении перед лицом изменений во внешней и/или внутренней среде. Таким образом, авторы полагают, что в этой статье подтверждается мнение Юнга о том, что регрессия - это не только «возврат» к прошлым формам мышления, аффектов и поведения, но и то, что регрессивные процессы дают значительный импульс для психологического роста и развития.
Como hemos mostrado en nuestros trabajos previos (‘Regresión I. Abordajes experimentales hacia la regresión’), el mecanismo común de la regresión puede ser descripto como desdiferenciación reversible, el cual es comprendido como un relativo incremento en la proporción de sistemas de baja-diferenciación en la experiencia actual. Data experimental muestra que la regresión luego de una enfermedad (tensión de cabeza crónica) es seguida por la adaptación y por un incremento en la diferenciación de sistemas en aquel dominio de la experiencia, que contiene sistemas responsables para tal adaptación. Los resultados del modelo matemático sostienen la idea de que la desdiferenciación reversible puede ser uno de los mecanismos para incrementar la efectividad de la adaptación a través del aprendizaje. La desdiferenciación reversible, la cual fenomenológicamente se describe como regresión, es un mecanismo general para restructurar las interacciones entre el organismo y el medio ambiente, en situaciones en las que las conductas que eran efectivas en el pasado se vuelven ineficaces. La desdiferenciación reversible ha evolucionado como un componente de la adaptación cuando se forman nuevas conductas y se requieren modificaciones a gran escala en las conductas existentes frente a los cambios en el medio ambiente externo y/o interno. Así, los autores consideran que el artículo proporciona evidencia a la perspectiva de Jung sobre la regresión, no solamente como un ‘retorno’ a formas de pensar, sentir y actuar del pasado sino que los procesos regresivos proveen un estímulo significativo para el desarrollo y el crecimiento psicológico.
退行II:通过退行得以发展 在第一篇文章中 (退行I:退行的实证取向), 退行的一般机制可以被描述为一种可逆的去分化, 这可以理解为, 低分化的 (旧的)系统在实际经验中所占比例的相对增长。实验数据显示, 与退行相随的疾病 (慢性紧张性头痛)之后, 会发生适应, 以及系统分化的增长, 因为这一经验领域包含了作用于适应的系统。数学建模的研究结果也支持这一观念, 即可逆的去分化是一种通过学习来增进适应效率的机制。可逆的去分化在现象学上被描述为退行, 它是一种普遍的机制, 用以重建有机环境中的互动, 在这些情境中, 以往有效的行为开始失效。当新的行为形成, 个体为了面对内外环境的变化, 对已有行为进行必要的大尺度调整时, 可逆的去分化便进化为适应的一个组成部分。于是, 作者相信这篇文章为荣格的退行观点提供了支持, 即退行不仅仅是“回归”过往的思维方式、情感和行为, 而是说, 退行还为心理成长与发展提供了重要的动力。.

The concept of regression is considered with an emphasis on the differences between the positions of Freud and Jung regarding its significance. The paper discusses the results of experimental analyses of individual experience dynamics (from gene expression changes and impulse neuronal activity in animals to prosocial behaviour in healthy humans at different ages, and humans in chronic pain) in those situations where regression occurs: stress, disease, learning, highly emotional states and alcohol intoxication. Common mechanisms of regression in all these situations are proposed. The mechanisms of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the representation of low-differentiated (older) systems in the actualized experience. In all of the cases of dedifferentiation mentioned above, the complexity of the systemic organization of behaviour significantly decreases.
Le concept de régression est étudié en mettant l’accent sur les différences entre les positions de Freud et celles de Jung concernant sa portée. L’article discute les résultats des analyses expérimentales de dynamiques de l’expérience individuelle (de changements dans l’expression des gènes et de l’activité des réflexes neuronaux chez les animaux aux comportements pro-sociaux chez des humains en bonne santé et à des âges de vie divers, et chez des humains en situation de souffrance chronique) dans ces situations où se produit la régression: le stress, la maladie, l’apprentissage, les états hautement émotionnels et l’intoxication par l’alcool. Les mécanismes communs de régression dans toutes ces situations sont présentés. Les mécanismes de régression peuvent être décrits en tant que dé-différentiation réversible, ce qui est interprété comme un accroissement relatif de la représentation de systèmes peu-différenciés (plus vieux) dans l’expérience actualisée. Dans tous les cas de dé-différentiation mentionnés plus haut, la complexité de l’organisation systémique du comportement décroit de manière significative.
Das Konzept der Regression wird unter besonderer Berücksichtigung der Unterschiede zwischen den Positionen von Freud und Jung auf seine Tragweite hin untersucht. Der Aufsatz diskutiert die Ergebnisse experimenteller Analysen der individuellen Erlebensdynamik (von Veränderungen der Genexpression und der impulsiven neuronalen Aktivität bei Tieren bis hin zu prosozialem Verhalten bei gesunden Menschen unterschiedlichen Alters und Menschen mit chronischen Schmerzen) in Situationen, in denen Regressionen auftreten: Streß, Krankheit, Lernen, sehr emotionale Zustände und Alkoholvergiftung. In all diesen Situationen werden gemeinsame Regressionsmechanismen angenommen. Diese Regressionsmechanismen können als reversible Entdifferenzierungen beschrieben werden, die als relativer Anstieg der Repräsentation niedrig differenzierter (älterer) Systeme in der aktualisierten Erfahrung verstanden wird. In allen oben genannten Fällen der Entdifferenzierung nimmt die Komplexität der systemischen Organisation des Verhaltens signifikant ab.
Il concetto di regressione viene considerato con un’enfasi sulle differenze tra le posizioni di Freud e Jung riguardo al suo significato. L’articolo discute i risultati di analisi sperimentali delle dinamiche dell’esperienza individuale (dalle modificazioni nell’espressione genetica e dall’impulso dell\'attività neuronale negli animali fino al comportamento prosociale in esseri umani sani in età differenti, e in esseri umani con dolore cronico) in quelle situazioni in cui si verifica la regressione: stress, malattia, apprendimento, stati altamente emotivi e intossicazione alcolica. Vengono proposti meccanismi comuni di regressione in tutte queste situazioni. I meccanismi di regressione possono essere descritti come dedifferenziazione reversibile, che è intesa come un aumento relativo della rappresentazione di sistemi a bassa differenziazione (più vecchi) nell’esperienza attualizzata. In tutti i casi di dedifferenziazione sopra menzionati, la complessità dell’organizzazione sistemica del comportamento diminuisce significativamente.
Понятие регрессии рассматривается в свете различий взглядов Фрейда и Юнга на значение регрессии. В статье обсуждаются результаты экспериментального анализа динамики индивидуального опыта (начиная от изменений генной экспрессии и спайковой активности нейронов у животных до просоциального поведения у здоровых людей в разные возрастные периоды и людей, испытывающих хроническую боль) в ситуациях, в которых происходит регрессия: стресс, болезнь, обучение, состояния сильного эмоционального возбуждения, алкогольная интоксикация. Обосновывается представление об общности механизмов регрессии во всех этих ситуациях. Механизмы регрессии могут быть описаны как обратимая дедифференциация, под которой понимается относительное увеличение представленности низко-дифференцированных (старых) систем в актуализированном опыте. Во всех случаях упомянутой выше дедифференциации, сложность системной организации поведения существенно снижается.
Se considera el concepto de regresión, con énfasis en las diferencias entre Freud y Jung en lo que concierne a su significado. El trabajo desarrolla los resultados de análisis experimentales sobre dinámicas experienciales individuales (desde cambios en la expresión genética y actividad neuronal en animales a conductas prosociales en humanos saludables en diferentes edades, y humanos en dolor crónico) en aquellas situaciones donde la regresión ocurre: estrés, enfermedad, aprendizaje, estados altamente emocionales e intoxicación alcohólica. Se proponen mecanismos comunes de regresión en todas estas situaciones. Los mecanismos de regresión pueden describirse como de-diferenciación reversible, la cual es comprendida como un incremento relativo de la representación de sistemas de baja-diferenciación (antiguos) en la experiencia actualizada. En todos los casos de de-diferenciación mencionados anteriormente, la complejidad de la organización sistemática de conducta decrece significativamente.
退行I:退行的实证取向 退行的概念被认为凸显了弗洛伊德和荣格关于退行的重要性的不同理解。文章讨论了关于个体处于退行发生的情境时, 其经验动力的实证分析的结果 (这些分析涉及动物基因表达的改变和神经元脉冲活性, 以及不同年龄健康人类亲社会的行为, 和慢性疼痛的病人), 这些导致退行的情境包括:压力, 疾病, 学习, 高情绪化状态, 酒精中毒。这些情境下常见的退行机制都在文中提及。退行的机制可以被描述为可逆的去分化, 这可以被理解为在实现经验中, 低分化的 (老一些的)系统表现出的相对增长。在所有以上提及的去分化案例中, 系统化组织的行为的复杂性显著降低了。.

The study of the human microbiome has led to an exceptional increase in the current understanding of the importance of microbiota for health throughout all stages of life. Human microbial colonization occurs in the skin, genitourinary system and, mainly, in the oral cavity and intestinal tract. In these locations, the human microbiota establishes a symbiotic relationship with the host and helps maintain the physiological homeostasis. Lifestyle, age, diet and use of antibiotics are the main regulators of the composition and functionality of human microbiota. Recent studies have indicated the reduction in microbial diversity as one of the contributors to the development of diseases. In addition to phylogenetic diversity studies, further metagenomic studies are needed at the functional level of the human microbiome to improve our understanding of its involvement in human health.

BACKGROUND: Neurologists refer to numerous \"syndromes,‿ consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative \"diseases,‿ on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage.
METHODS: We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic.
CONCLUSIONS: Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new \"diseases‿ should be defined and adapted to current knowledge and practice.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

OBJECTIVE: To analyze the psychometric properties of the Parents\' Perception of Uncertainty in Illness Scale, parents/children, adapted to Spanish.
METHODS: A descriptive methodological study involving the translation into Spanish of the Parents\' Perception of Uncertainty in Illness Scale, parents/children, and analysis of their face validity, content validity, construct validity and internal consistency.
RESULTS: The original version of the scale in English was translated into Spanish, and approved by its author. Six face validity items with comprehension difficulty were reported; which were reviewed and adapted, keeping its structure. The global content validity index with expert appraisal was 0.94. In the exploratory analysis of factors, 3 dimensions were identified: ambiguity and lack of information, unpredictability and lack of clarity, with a KMO=0.846, which accumulated 91.5% of the explained variance. The internal consistency of the scale yielded a Cronbach alpha of 0.86 demonstrating a good level of correlation between items.
CONCLUSIONS: The Spanish version of \"Parent\'s Perception of Uncertainty in Illness Scale\" is a valid and reliable tool that can be used to determine the level of uncertainty of parents facing the illness of their children.

The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care. Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date. Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care.