Introduction
One of the challenges related to global health is the imbalanced distribution of health professionals and the HIV/AIDS pandemic. Under this situation, the importance of HIV/AIDS care with health volunteers has been recognized, especially in developing countries, which suffer from the double burden. A task shifting approach is encouraged among health professionals, as well as, between health professionals and non health professionals.
Objective
To discuss supportive surroundings for sustainable HIV/AIDS care with heath volunteers from the perspective of motivation.
Methods
A literature review, where articles were searched and extracted through the PubMed database, was conducted in May, 2010. In total, 16 combinations with 11 keywords were used for searching. (First keyword: motivation, second keyword: HIV or AIDS, third keyword: community health aides, community health workers, community workers, lay counselors, adherence support workers, adherence counselors, care givers or volunteers)
Results
Among the 290 articles extracted, nine articles meeting the criteria of this literature review were selected. Eight articles were reported from developed countries and one article was from a developing country. About half of the study participants in six articles were People With HIV (PWH) or homosexuals. Through all articles, “altruism” and “self development” were recognized as motivation for health volunteers to join and maintain activities. Especially for continuity of activities, “support from other members and staff” and “recognition” were raised. Specific motivation from a developing country was the “ step to formal employment”.
Discussion and Conclusion
Regardless of developed- or developing- countries, fundamental motivation of health volunteers for HIV/AIDS care is similar. However, in developing countries, where health volunteers are adopted as part of the health system, adequate and continuous support and supervision are required more than in developed countries for sustainability of stable care provision. PWH can, also, play an active role as HIV/AIDS care providers by themselves, and they will be a key component for HIV/AIDS care. Further exploration is necessary to determine the motivation of health volunteers for HIV/AIDS care in developing countries where a task shifting approach is encouraged under a shortage of health professionals and HIV/AIDS epidemic.

Medical ethics is taught as a principle of medicine at medical schools in Japan. However, the best way to teach medical students about decision-making in ethical dilemmas in unclear. Therefore, we conducted a survey of 80 medical schools in Japan to identify the current issues in the teaching of medical ethics. We asked how and when students learned about medical ethics at medical school and asked about the objectives, achievement goals, contents, and curricula for the first to sixth years and postgraduate studies.1) A preliminary study of educational affairs at faculties of medicine (response rate, 99%) showed that medical ethics is most likely to be taught in the earliest year (first year, 61%) and is less likely to be taught in later years (fifth or sixth year, 11%). 2) Only 28% of lecturers who teach medical ethics are familiar with the whole curriculum of medical ethics, and only 15 medical schools had cross-faculty teaching.3) Lecturers' satisfaction with the system of teaching medical ethics at medical schools was related with the introduction of the elements of medical ethics at bedside teaching (odds ratio=7.4, p<0.01).4) A logistic regression model adjusted for lecturers' specialties indicated that sufficient content for teaching medical ethics was associated with classroom discussions with clinicians (odds ratio=9.3, p<0.05).5) Despite the recently increased recognition of the importance of teaching medical ethics, the human resources for teaching medical ethics at medical schools are scarce and insufficient. Urgent responses are needed to address current shortcomings in the teaching system and the advanced training of teachers.

Purpose: To clarify the effect of a palliative care team intervention for nausea of cancer patients. Methods: The study participants were all cancer patients who were referred to a palliative care team in Yodogawa Christian Hospital in 2010, and had nausea with score 2 or over of the Support Team Assessment Schedule Japanese version (STAS－J). The causes of nausea were classified into 4 categories. Etiology－based antiemetic medications were recommended, and the intensities of nausea were assessed using the STAS－J on the day of referral, and 7 days after. Result: Among 27 patients were recruited for this study, 24 were assessed 7 days after. Nine patients had chemically induced nausea, eight had impaired gastric emptying, four had vestibular and central nervous system disturbance, and three had bowel obstruction. The mean STAS－J score significantly decreased from 3.0 (SD, 0.55) on the day of referral to 1.1 (0.80) after 7 days (p＜0.001). Two patients had mild drowsiness. Conclusion: The recommendations of etiology－based antiemetics by the palliative care team may be effective for managing nausea in cancer patients.