The results indicate that more marginalised women (i.e., young, unmarried, low levels of education) and those with no previous deliveries were significantly less likely to have the WHO recommended number of 5 ANC visits. Further analysis revealed variations between facilities in the determinants of sufficient ANC visits. These findings show inequalities in utilisation which may suggest that inequities in access remain. Extant reviews of peer and social support interventions are disease-and approach-specific (e.g., use of community health workers in diabetes management). Because there is limited evidence within any one disease, such reviews do not provide strong evidence for peer support. In contrast, a more general review of peer support across a range of health behaviors can lead to more solid conclusions about its effectiveness. We conducted a systematic review of research on peer support for complex health behavior (e.g., cardiovascular risk reduction) across a variety of health problems. An initial PubMed search of papers published between 1/1/2001 and 8/31/2009 and using cognates of "coach," "promotora," "peer support," etc. identified 902 peer-reviewed articles. Of these, 595 articles were excluded as their titles indicated that they were not patient behavior programs (e.g. coaching for career growth among health professionals). The remaining 307 were reviewed to fit a broad definition of peer support: provided by a nonprofessional and addressing support for multiple health behaviors over time. Exclusion criteria consisted of: Interventions focused on isolated or single behaviors (e.g. cancer screening); interventions evaluating educational classes; and those without outcome data. The resulting 40 papers addressed: breastfeeding (6 papers); diabetes (5 papers), depression (5 papers), and asthma (4 papers), along with a variety of other health issues, and represented 8 different countries. Provisional rating of outcomes was: No evidence of benefit; Modest evidence of benefit (e.g., changes on self report measure of health behaviors or quality of life); and Strong evidence of benefit (e.g. statistically significant changes on objective clinical measure such as blood pressure or blood glucose, or on well validated psychological measure such as the CES-D). Of the 40 papers, 7 were scored as No, 15 as Modest, and 18 as Strong Evidence of Benefit. Further evaluation of effect sizes and weighting by sample sizes and adequacy of controls will be included in presentation at the Congress. This systematic review indicates that peer support is effective in promoting complex health behaviors across a variety of diseases and national settings. Background: Nepal is one of the least developed countries in the world. Poverty, illiteracy, poor public health system are tremendously impacting on majority of people's lives who are living in rural areas and limited access to primary health care services. The government of Nepal declared the free health care policy from early 2008 with a view to improve access to and utilization of health services for people who are poor, socially disadvantaged and marginalized communities. The new health policy has highlighted the needs to expand health services in rural areas where there is acute lack of human resources, irregular supplies of drugs and equipment and poor health infrastructure. The pro-poor health policy aims to narrow the wider gaps of disparities in health care by ensuring health equity and the rights of people to their health and life. Objective: The objective of this study is to explore the effects of pro-poor health care policy at the community levels. Methods: It was a cross-sectional study with primary focus on qualitative research methodology. The methods for data collection were focus group discussion and in-depth interviews with service providers in local health facilities, community groups, key informants and the beneficiaries. Besides, the data from health management information system at local health facilities were reviewed to analyze the trend of health service utilization over the period of two years. Results and Conclusions: The pro-poor health policy has been positively impacting on people's access to and utilization of health services. There is 15 to 20 % increment in health facility utilization by poor, socially disadvantaged and marginalized communities. There is significant level of community awareness of free health care policy and provision. The supplies of drugs and other logistics at health facilities are gradually improved in the rural areas where as human resources for health are still lacking and not adequate compared to the health care needs of the people. The pro-poor health policy has been instrumental in accessing and utilizing the services by the poorest of the poor as it is free of charge and available in local health facilities. Social support is thought to be a health protective resource, however, the underlying mechanisms are elusive. One possible mechanism is that social support has a buffering effect on the sympathetic stress response. The salivary enzyme alpha-amylase (sAA), reflecting the activity of the sympathetic nervous system (SNS), seems to be a promising indicator for stress research. The main purpose of the present study was to test the effect of perceived social support (PSS) on acute sAA stress reactivity. Thirty-three healthy, young male subjects participated in a computerized stress task consisting of arithmetic problems that had to be solved under time-pressure and social evaluation. Cortisol, sAA, salivary flow rate (SFR), heart rate (HR), and respiratory sinus arrhythmia (RSA) were assessed repeatedly, while perceived social support, chronic stress and rated stress reactivity were assessed using different questionnaires. Higher PSS was negatively correlated with the stress response of sAA (r=-.551, p<.01) and HR (r=−.344, p<.05), but was unrelated to cortisol, SFR, and RSA alterations. Furthermore, higher levels of PSS were negatively associated with ratings of chronic stress (r=−.384, p<.05) and habitual stress reactivity (r=−.372, p<.05). This is the first study examining the relationship between PSS and acute sAA stress reactivity. The results indicate that social support indeed buffers the effect of psychosocial stress on the SNS activity, and is further inversely associated with ratings of chronic stress and stress reactivity. In addition, our findings emphasize the relevance of sAA for stress and social support research. Music listening has been suggested to beneficially impact health via stress-reducing effects. However, the exact mechanisms through which music exerts its positive consequences on the body are poorly understood. It was the aim of the current study to address this gap in knowledge and to examine the underlying mechanisms of music effects across neuroendocrine, autonomous, cognitive, and emotional domains of the human stress response. Sixty healthy female volunteers (mean =25.27 years) were exposed to a standardized psychosocial stress test after having been randomly assigned to one of three different conditions prior to the stressor: 1) relaxing music ('Miserere', Allegri) (RM), 2) sound of rippling water (SW) and 3) rest without acoustic stimulation (R). Salivary cortisol and alpha-amylase (sAA), anticipatory cognitive appraisal, subjective stress perception and anxiety were repeatedly assessed in all subjects. We hypothesized that listening to music prior to the stressor, compared to SW or R would result in an attenuated stress reaction. The stressor caused significant changes in all measurements in all three groups over time. The three conditions significantly differed regarding cortisol responses (p=0.014), with highest values in the RM and lowest values in SW. sAA recovery delta showed a statistical trend (p= 0.060) in favor of the RM. Psychological measures did not significantly differ between groups during the experiment. Our findings indicate that music listening differentially impacts the psychobiological stress system. Listening to music prior to a psychological stressor increases rather than attenuates subsequent endocrine stress responses. In contrast, listening to water sound seems to result in an attenuated endocrine response to stress compared to no auditory stimulation. Listening to music seems to increase autonomic recovery more efficiently than listening to water sound or resting in silence. These findings bear potential to explain the effects of music on the human body. The aim was to study if health, reaction time, and the diurnal rhythm of cortisol were negatively affected when a group of shift workers changed their work schedule from ordinary night-day shift to "swing shift". This was tested on 19 healthy workers on a Norwegian oil rig in the North Sea. They worked two weeks offshore followed by 4 weeks off work. The ordinary schedule was to work 12-hour day shift during one work period (14 days), and 12-hour night shift on the next work period (14 nights)(fixed-shift). "Swing shift" involves night shift during the first week, then day shift the second week, for every working period. The advantage of swing shift is that the workers are readapted to a normal day-night rhythm when they start their 4 week off work period. The disadvantage is that the workers have to adjust their biological rhythms twice every work period instead of once every other work period. All participants worked ordinary night-day shift when baseline data were collected (questionnaires, saliva cortisol, and reaction time during work). After collection of baseline data the workers changed their work schedule to "swing shift", one year later the same data were collected. "Swing shift" did not give any negative health effects or any negative changes in reaction time during the day they shifted from night work to day work. During swing shift the cortisol rhythm went slowly back to a normal rhythm in the second week, but it was not fully returned to normal values when they returned home for the 4 weeks off period. When working swing shift the cortisol rhythms were readapted to normal values after one week at home. For personnel returning home directly from 14 consecutive night shifts, diurnal cortisol adaptation was not complete after one week at home. Low vagal function is related to several disorders. One possible underlying mechanism linking the vagus nerve and disorders is the HPA axis, although literature referring to this association is inconsistent. The main purpose of the present study was to examine the relation between vagal function and the biopsychological reactivity to acute psychosocial stress. Healthy male subjects (N =33) participated in a stress task (Montreal Imaging Stress Task, MIST; Dedovic et al., 2005) , while heart rate (HR), respiratory sinus arrhythmia (RSA), salivary cortisol and mood were assessed. Vagal function was determined using baseline, MIST-induced inhibition and Cold Face Test (CFT)-induced stimulation. The stress task induced a significant increase in cortisol and HR (both p<.001) and a decrease in RSA and mood (both p<.001). A linear regression model with CFT response predicted 17.9% of observed variance in cortisol AUCI (mood: 38.9%; tiredness: 19.8%) in response to the stressor. The results indicate that faster or stronger CFT response is associated with reduced cortisol increase, increased mood and wakefulness after acute stress. Our data support an inverse relationship between vagal function and the HPA axis. Emotional distress-induced up-regulation of Interleukin-6 (IL-6) has been found to be detrimental to health. As diabetic foot ulcers are characterized by chronic inflammation, it is plausible that emotional distress could delay the healing of such ulcers by upregulating and sustaining high ulcer tissue-specific levels of IL-6. Here we report a cross-sectional study of 41 patients with type 2 DM (76% male; mean age 55 yrs) and plantar neuropathic diabetic foot ulcers (University of Texas Classification: 82% grade 1A; 12% 1B; 3% 2A; and 3% 2B). The relationship between patient self reported generalized emotional distress, foot ulcer-specific emotional responses and ulcer biopsy IL-6 levels was investigated. Ulcer-specific IL-6 levels were determined via quantification of immunohistochemical wound biopsy tissue localization. Additionally, assessed was the physiologic marker of emotional distress, 9 am and 12noon serum cortisol (458.7±125.8 nmol/l and 625± 369.7 nmol/l, respectively). In the bivariate analysis, more severe generalized and foot-ulcer-specific emotional distress were each associated with higher levels of ulcer biopsy log-transformed IL-6 (raw mean: 608.3±545.5 cells/mm2): HADS-Anxiety (r=0.44; p= 0.031), PSS (r=0.44; p=0.034), PIN-Amputation Worry (r=0.54; p=0.007) and NeuroQoL-Interpersonal Burden (r=0.60; p= 0.004). No significant relationship was noted between serum cortisol and IL-6. These preliminary findings identify a strong link between subjective measures of emotional distress and wound specific IL-6 up-regulation. Whether this relationship contributes to non-healing of diabetic foot ulcers is under investigation. Chronic multi-symptom illnesses such as Fibromyalgia Syndrome (FMS) and Temporomandibular Disorders (TMD) are accompanied by complex interactions of cognitive, emotional, and physiological disturbances. Such conditions are complicated and draining to live with, and successful adaptation may depend on ability to self-regulate. Self-regulation involves capacity to exercise control and guide or alter reactions and behavior. Research indicates that self-regulatory strength is a limited source that can be depleted or fatigued, however, and patients with FMS and TMD may, when trying to adapt to the many demands of their illnesses, deplete or fatigue their self-regulatory resources. The current study aimed to show that patients with FMS and TMD, compared with healthy controls, are more vulnerable to selfregulatory fatigue as a consequence of their condition, and that self-regulatory fatigue has specific physiological markers. Research has found self-regulatory effort to lead to self-regulatory fatigue, indicated by less capacity to persist on a subsequent task. Patients (N=50) and matched controls (N=50) were exposed to an experimental self-regulation task, followed by a persistence task. Controls in the low self-regulation condition displayed continued high persistence as expected. However, patients in the same condition displayed similar persistence as patients and controls in the high self-regulatory condition, indicating that patients with FMS and TMD may in fact be suffering from chronic selfregulatory fatigue. Baseline heart rate variability, heart rate, blood glucose, and cortisol predicted persistence, more so for controls than for patients, and more so in the low versus high selfregulation condition. Impact of illness on self-regulatory effort was mediated by pain, but not by any other factors. The current study shows that patients with chronic multi-symptom illnesses likely suffer from chronic self-regulatory fatigue, and that selfregulatory capacity needs to be taken into account when aiming to treat and help these patients through behavioral interventions. Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands and 3 University Centre for Sport, Exercise and Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.