Background Rheumatic diseases are heterogeneous clinical conditions that often lead to functional disability with consequent impairment of Quality of Life (QoL). Assessing the risk factors of disability is required to find improvement strategies geared toward patient empowerment and implementation of current health services. Objectives The aim of the present observational-descriptive study was to analyse the impact of disability in an Italian cohort of rheumatic patients and suggest nursing intervention hypotheses to approach disability-related problems and improve QoL in rheumatology patients. Methods Data collection was carried out through in-person or remote interviews with rheumatic patients of a Rheumatology Unit in Florence, Italy. The interviews aimed at observing the phenomenon of disability and the following questionnaires were administered: Short Form-12 (SF-12) for QoL, Health Assessment Questionnaire (HAQ-DI) for disability, Visual Analogue Scale (VAS) for pain, Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH) for workability. Afterwards, the nursing group met to discuss the results and, based on recent literature, propose strategies for approaching the patient with disabilities in daily clinical practice. Results 21 rheumatic patients were interviewed. For mental and physical health SF-12 showed scores of 47.6 and 46.1, respectively. Pain level averaged 2.2 score, while disability index as assessed with HAQ-DI was 0.3 score. As for the workability, 50% of the sample interviewed work on average for 33.6 hours with a mean of 2.6 hours of absence from work due to the disease. Lastly, 6.25% report work suspension with disability pension due to illness. Nursing intervention hypotheses to curb disability-related problems and improve QoL in rheumatology patients are summarized as follows in Figure 1. Conclusion Psychological well-being falls within the determinants of QoL, jointly with other factors such as occupational and relational well-being and control of disease progression, in line with the reviewed studies. Understanding and investigating the determinants of QoL for each patient is the starting point for holistic care geared toward his or her well-being: this attitude cannot be separated from a multidisciplinary approach by healthcare professionals. References [1]Stucki G et al (2003) Understanding disability Ann Rheum Dis. 62(4):289-90. doi: 10.1136/ard.62.4.289.[2]Juan J et al (2017) Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis. Health and Quality of Life Outcomes. doi: 10.1186/s12955-017-0659-z.[3]Bombardier C et al (2011) The relationship between joint damage and functional disability in rheumatoid arthritis: A systematic review. Annals of the rheumatic diseases. 71. 836-44. doi: 10.1136/annrheumdis-2011-200343. Acknowledgements: NIL. Disclosure of Interests None Declared.Figure 1Proposals for nursing approach in disability

OBJECTIVES:The aim of our study was to evaluate the effect of animal-assisted intervention (AAI), a complementary support to traditional therapies focused on the interaction between animals and human beings, in improving psychological trait, anxiety and pain in a cohort of systemic sclerosis (SSc) patients.METHODS:42 SSc patients, undergoing iloprost intravenous infusion, were divided in three groups: 1) 14 patients submitted to 20 AAI sessions; 2) 14 patients engaged in alternative social activity (control group 1 - C1); and 3) 14 patients without any alternative activity (control group 2 - C2). All patients underwent Visual Analog Scale (VAS), the State-anxiety (STAI-S) and emotional faces at the beginning (s0) and at the end (s1) of each single session, while General Anxiety State-Trait Anxiety Inventory (STAI-T), Beck Depression Inventory (BDI), Social Interaction Anxiety Scale (SIAS), Eysenck Personality Questionnaire-Revised (EPQ-R), the Social Phobia Scale (SPS), the Toronto Alexythymia Scale (TAS-20), the Thought Control Questionnaire (TCQ) were administered at baseline (t0) and at the end of the project (t1).RESULTS:AAI group showed a significant decrease of the anxiety state level in respect to the two control groups (p<0.001). VAS scale resulted lower both in AAI (p < 0.001) and C1 group (p<0.01). Moreover, STAI-T and TAS scores were significantly reduced in AAI group (p<0.001). TCQ scale showed that patients treated with AAI, compared to control group C2, had greater capacity to avoid unpleasant and unwanted thoughts (p<0.05). In AAI group, the EPQ-R test revealed an enhancement of extroversion trait compared to both control groups (p<0.05).CONCLUSIONS:Our data show that AAI significantly reduces pain perception, anxiety, neuroticism and ameliorates patients' social interaction, therefore it may be a useful to allow a better compliance to traditional therapies.

Betulinic acid (BA), Oleanolic acid (OA) and Ursolic acid (UA), are pentacyclic triterpenoids with widespread occurrence throughout the plant kingdom, these compounds are widely recognized by their pharmacological and biological properties, such as, anti-tumoral, anti-inflammatory, anti-microbial and hepatoprotective activity. In this work we determined the inhibitory ability of these compounds on the enzymatic, hemorrhagic, myotoxic and edema-inducing activities of Batx-I, a P-I metalloproteinase isolated from Bothrops atrox venom. BA, UA and OA inhibited the proteolytic activity of Batx-I on gelatin with IC50 values of 115.3, 223.0 and 357.3 μM, respectively. Additionally, these compounds showed inhibition of the hemorrhagic activity of Batx-I in skin with IC50 345.7, 643.5 and 1077.0 μM for BA, UA and OA in preincubation experiments. In studies with independent-injection, in which Batx-I was injected and then, at the same site, a concentration of 600 μM of each compound were administered at either 0, 5 or 10 min, BA showed a significant reduction of hemorrhage at 0 and 5 min. In addition, these compounds inhibited myotoxicity and edema-forming activity of Batx-I at 600 μM concentration. Molecular docking studies suggested that these compounds could occupy part of the substrate binding cleft of the enzyme affecting its catalytic cycle. In this manner, triterpenic acids are candidates for the development of inhibitors for the prevention of local tissue damage in snakebite envenomation.

The process whereby objects and representations come to be attention grabbing and capture thought and behaviour is called salience, and it is defined as aberrant when a significance is allocated to neutral stimuli. The Aberrant Salience Inventory (ASI) is a scale to measure aberrant salience, characterized by 29 dichotomic items. By now, a correlation between aberrant salience and eating disorders is unknown. Aim of this study is to evaluate an alteration of salience in patients with anorexia nervosa, to estimate the existance of a correlation between aberrant salience and the experience of body shape.MethodsTwenty-six female patients with AN (diagnosed using DSM-5) were enrolled at the Psychiatry Department of Florence. Psychopathological features were assessed at the time of enrollment using the following scales: SCL-90-R, BUT, EDE-Q. Salience alteration was assessed by the means of the ASI. Statistical analysis were realized using SPSS 20.0 with Spearman bivariate correlation.ResultsMean age was (mean ± SD) 26.2 ± 8.72 and mean Body Mass Index (BMI) 16.1 ± 2.46. Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Symptom Index (PSDI) were estimated for BUT and SCL-90-R and compared to total value of ASI. Thus, we found a statistical significant (P < 0.05) direct correlation between ASI and BUTpsdi and ASI and SCL-90-Rgsi (correlation coefficient of 0.446 and 0.398, respectively).ConclusionIn this study, we found a significant direct correlation between Aberrant Salience Inventory (ASI) values and one dimension of body uneasiness in anorexic patients. These preliminary data need further studies with a wider sample to confirm the above-mentioned data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionIt is still a matter of debate whether LAI antipsychotics are able to significantly improve patient's attitude towards treatment.ObjectiveThe aim of this 12-month observational study was to investigate the impact of switching antipsychotic treatment from oral to LAI formulation on patient's attitude towards treatment and quality of life.MethodsA total of 41 schizophrenic patients (25 males, mean age 42.10 ± 11.88 years) were recruited. Patients were expected not to need significant changes in concomitant treatments. All patients were under a stabilized therapy with a single oral antipsychotic (either olanzapine or paliperidone) and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic (olanzapine pamoate or paliperidone palmitate). Patients were assessed before the switch (T0), and after 6 (T1) and 12 months (T2) of LAI antipsychotic treatment by means of the YMRS, MADRS, PANSS, DAI-10 and SF-36.ResultsOur data evidenced an overall significant improvement of psychopathology, adherence and quality of life over the 12-month period (T0 vs. T2). In particular, while all of the measures significantly improved in the first semester (T0 vs. T1), only YMRS, positive PANSS and DAI-10 improved both in the first and in the second semester (T1 vs. T2), indicating an additional advantage of a prolonged LAI treatment on these clinical dimensions.ConclusionsThe switch from oral to long-acting antipsychotic treatment may provide considerable advantages in improving patient's attitude towards (and therefore adherence to) treatment. Part of this improvement could be related with a better efficacy on psychopathology and quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background Recently, the affective relationship between humans and animals has shown a potentially beneficial effects in clinical domains. However, the claim of different studies of the benefits of animal-assisted activities (AAA) is still lacking evidence base data. Objectives To gain insights into the effectiveness of AAA, physiotherapy and psychological support in SSc. Methods 12 SSc female patients (mean age of 60.52±8.3) were treated once a week by a team made of a dog-handler a rheumatologist and a psychologist. They underwent 10 dog-assisted interventions. At onset and after 3 months, the questionnaires and self reports were completed: pain evaluation (VAS 0-100), emotional and affective evaluation (Happy Face-Sad Face Scale), state anxiety (STAI), and a specific designed self report on the liking and satisfaction of the AAA interventions (AAA-Q). Results Significant improvements were reported for pain perception, mood, and other measures of distress among patients after AAA. Pain decreased significantly (p<0.05) in 73% of patients (VAS 0-100mm) after AAA (24.99 mm vs 16.18 mm). The regular interaction with dogs has showed to increase positive affective and social behaviors. Specifically, the emotional scale showed a significant enhancement of mood and positive feelings after AAA (1.98 vs 0.66) (p<0.05). We found increase social awareness, promoting social skills reducing anxiety and depressive symptoms (STAI X1->76±7.5 vs 62±4.3) significantly different before and after AAA (p<0.03). Conclusions This is the first study measuring the efficacy of AAA (with dogs) on the physiological, emotional, social well-being and pain perception in SSc. The study provides the evidence for pain control with enhancement of the psychosocial well-being. AAA integrated with the traditional medical approach may provide a good support for SSc patients. Disclosure of Interest None declared

Aberrant salience is the incorrect assignment of salience, significance or value to different innocuous stimuli. It seems closely related with dysregulation of the dopamine system that in turn relates with proneness to develop psychosis. To evaluate aberrant salience processing in a clinical trans-diagnostic sample, its relationship with anamnestic psychotic symptoms and current psychopathology, and possible variations of aberrant salience after three months of clinical-based treatment. Twenty inpatient subjects attending the Psychiatric Unit (Florence University) were recruited: 3 with Major Depression Disease, 6 with Schizophrenia, 3 with Bipolar Disorder, 4 with Obsessive-Compulsive Disorder, 4 with Eating Disorders. Patients were assessed by means of a clinical interview (SCID-I/P) and several questionnaires (AMDP, MADRS, HAM-A, MRS, PANSS and Aberrant Salience Inventory-ASI) at enrolment (T0) and after an individual and clinical-based treatment lasting 3 months (T1). At T0 subjects with positive ASI (cut-off>14) reported more frequently past and lifetime psychotic symptoms (p<0.05) and constituted a distinct cluster from patients with ASI score < 14. A positive anamnesis of psychotic symptoms was significantly correlated with AMDP susbscales (delusions and perception disturbances), PANSS pos, PANSS neg, PANSS tot scores (p<0.05). A significant reduction of mean MADRS, PANSS tot and HAM scores between T0 and T1 was found (p<0.05). No differencesin ASI scores between T0 and T1 were observed. Aberrant salience is significatively associated to lifetime psychotic symptoms. It represents a relevant psychopathologic dimension that, unlike other symptoms, seems not to significatively modify after pharmacological treatment and could represent a stable lifetime.