Talking Dead. New burials from Tron Bon Lei (Alor Island, Indonesia) inform on the evolution of mortuary practices from the terminal Pleistocene to the Holocene in Southeast Asia.

Burial elaborations are a human behaviour that, in recent contexts can inform on social diversification, belief systems, and the introduction of new practices resulting from migration or cultural transmission. The study of mortuary practices in Mainland and Island Southeast Asia has revealed complex and diverse treatments of the deceased. This paper contributes to this topic with the description of three new burials excavated in Tron Bon Lei (Alor Island, Indonesia) dated to 7.5, 10, and 12 kya cal BP. In addition to the bioskeletal profiles and palaeohealth observations, we propose the adoption of archaeothanatological methods to characterise burial types in the region. Through the analysis of skeletal element representation, body position, articulation, and grave associations, we provide an example of a holistic approach to mortuary treatments in the Lesser Sunda Islands. Our results provide significant new data for understanding the evolution and diversification of burial practices in Southeast Asia, contributing to a growing body of literature describing prehistoric socio-cultural behaviour in this region.

New insights on commemoration of the dead through mortuary and architectural use of pigments at Neolithic Çatalhöyük, Turkey.

The cultural use of pigments in human societies is associated with ritual activities and the creation of social memory. Neolithic Çatalhöyük (Turkey, 7100-5950 cal BC) provides a unique case study for the exploration of links between pigments in burials, demographic data and colourants in contemporary architectural contexts. This study presents the first combined analysis of funerary and architectural evidence of pigment use in Neolithic Anatolia and discusses the possible social processes underlying the observed statistical patterns. Results reveal that pigments were either applied directly to the deceased or included in the grave as a burial association. The most commonly used pigment was red ochre. Cinnabar was mainly applied to males and blue/green pigment was associated with females. A correlation was found between the number of buried individuals and the number of painted layers in the buildings. Mortuary practices seem to have followed specific selection processes independent of sex and age-at-death of the deceased. This study offers new insights about the social factors involved in pigment use in this community, and contributes to the interpretation of funerary practices in Neolithic Anatolia. Specifically, it suggests that visual expression, ritual performance and symbolic associations were elements of shared long-term socio-cultural practices.

An infant burial from Arma Veirana in northwestern Italy provides insights into funerary practices and female personhood in early Mesolithic Europe.

The evolution and development of human mortuary behaviors is of enormous cultural significance. Here we report a richly-decorated young infant burial (AVH-1) from Arma Veirana (Liguria, northwestern Italy) that is directly dated to 10,211-9910 cal BP (95.4% probability), placing it within the early Holocene and therefore attributable to the early Mesolithic, a cultural period from which well-documented burials are exceedingly rare. Virtual dental histology, proteomics, and aDNA indicate that the infant was a 40-50 days old female. Associated artifacts indicate significant material and emotional investment in the child's interment. The detailed biological profile of AVH-1 establishes the child as the earliest European near-neonate documented to be female. The Arma Veirana burial thus provides insight into sex/gender-based social status, funerary treatment, and the attribution of personhood to the youngest individuals among prehistoric hunter-gatherer groups and adds substantially to the scant data on mortuary practices from an important period in prehistory shortly following the end of the last Ice Age.

A percepção de agentes funerários sobre morte e vida a partir de sua experiência laboral / The perception of morticians over death and life from their labor experience

Esta pesquisa pretendeu analisar como a experiência laboral do agente funerário afeta suas relações cotidianas e sua percepção sobre a morte. Realizaram-se entrevistas semiestruturadas com cinco agentes funerários no Sul do Brasil. Em uma sociedade onde o tema da morte é um tabu, ao se relacionar com o corpo falecido nos rituais funerários, são despertados no trabalhador questionamentos acerca da própria finitude. Os dados coletados foram submetidos a uma análise de conteúdo e discutidos a partir de uma perspectiva existencialista sartriana quando os conceitos como morte e projeto-de-ser foram explorados. Identificaram-se alguns fatores que podem dificultar o trabalho dos agentes, dentre eles: a falta de preparação para o atendimento da família enlutada, a dificuldade em se deparar com a questão da morte, os impactos de seu trabalho nas relações pessoais e a visão social sobre as características de seu trabalho.

This research aimed to analyze how work experience of morticians affects their daily relationships and perception of death. Semi-structured interviews were carried out with five funeral directors in southern Brazil. In a society where the theme of death is a taboo, when relating to the deceased body in funerary rituals, workers are awakened to questions about their own finitude. The collected data were subjected to content analysis and discussed from a Sartrian existentialist perspective, when concepts such as death and project-to-be were explored. Some factors that can make mortician's work difficult were identified, including: lack of preparation for the care of the mourning family, difficulty in facing the issue of death, the impacts of their work on personal relationships and the social vision about the characteristics of their work.

Mental Health Status of Canadian Funeral Service Workers at the Beginning of the COVID-19 Pandemic.

OBJECTIVE: To describe the mental health situation and job stress levels of Funeral Service Workers (FSW) during the first months of the pandemic. METHODS: We conducted a cross-sectional study in Canada between May and July 2020. Funeral service professional organizations were asked to spread a questionnaire to their members including job description, assessment of anxiety (GAD-7), depression (PHQ-8), and job stress (effort-reward imbalance questionnaire). RESULTS: Fifty-eight FSW completed a questionnaire, 32% reported anxiety symptoms (GAD-7 > 10), 29% reported depressive symptoms (PHQ-8 > 10), 31% reported job stress. Women were more likely to report overcommitment (66.7% vs. 31.8%, P = 0.015). CONCLUSIONS: Levels of anxiety and depression identified in Canadian FSW were higher than those identified in other occupational groups during the first few months of the pandemic.

Assessment of occupational health and safety practices at government mortuaries in Gauteng Province: a cross-sectional study.

INTRODUCTION: hospital mortuaries are responsible for the receipt and storage of deceased people. This exposes mortuary workers to a variety of health and safety hazards, which include physical, chemical, ergonomics, biological and psychosocial hazards/stressors. The aim of this study was to assess occupational health and safety practices (OHS) among government mortuary workers in Gauteng province. METHODS: a cross-sectional descriptive study design was conducted between the year 2017 and 2018. A convenient sampling technique was used to sample 11 government hospitals in Gauteng Province. A total of 46 employees participated in the study. Data was collected using structured questionnaires and observational checklists. Ethical clearance and permission to conduct the study were obtained prior to the commencement of the study. Data was analyzed using Statistical Package for the Social Science (SPSS) version 25 software. RESULTS: thirty-one (67%) of the respondents did not know the concept of hazard. Observations indicated that 5 out of 11 (45%) facilities were well maintained with only 2 (18%) of the facilities had the participants wearing the required PPE on duty. There was no association between working experience and having a knowledge of the existing hazards. However, there was a high correlation (P<0.05) between training and adherence to safe practices. CONCLUSION: the OHS practices were poor amongst operational employees. The study highlights the significance of developing and implementing Occupational Health and Safety programmes. We recommend that these programmes should focus on occupational health and safety education, training, supervision, medical surveillance and monitoring strategies must be developed and implemented.

Workplace safety concerns in medico-legal death investigations related to COVID-19.

The personnel involved in the management of COVID-19 affected dead bodies, including law enforcement personnel at the scene of crime, personnel involved in transportation of the dead bodies, forensic practitioners, autopsy pathologists, mortuary personnel, as well as the family members of the dead, etc. are at risk of exposure to SARS-CoV-2 infection. Post-mortem examination is a high-risk procedure, considering that it involves aerosol generating procedures, and exposure to body fluids. The safety of the forensic practitioners and support staff in the management of suspected or confirmed COVID-19 deaths hence, is of extreme importance, especially in the absence of pre-autopsy testing for COVID-19 and due to non-availability of adequate first-hand medical history of the deceased. This communication aims to highlight the current practices and advises certain guidelines in ensuring occupational health and safety in view of these risks in medico-legal death investigations.

SARS-CoV-2 infection in mortuary and cemetery workers.

BACKGROUND: Mortuary and cemetery workers may be exposed to the bodies of people with SARS-CoV-2 infection; however, prevalence of infection among these groups is unknown. METHODS: Nasopharyngeal swabs (NPS) for RT-PCR and serologic testing for SARS-CoV-2 were performed on mortuary and cemetery workers in Qatar. Data on specific job duties, living conditions, contact history, and clinical course were gathered. Environmental sampling was carried out to explore any association with infection. Logistic regression analysis was used to determine the factors associated with infection. RESULTS: Forty-seven mortuary workers provided an NPS and seven (14.9%) were PCR positive; 32 provided a blood sample and eight (25%) were antibody positive, six (75%) who were seropositive were also PCR positive. Among the 81 cemetery workers, 76 provided an NPS and five (6.6%) were PCR positive; 64 provided a blood sample and 22 (34.4%) were antibody positive, three (13.6%) who were seropositive were also PCR positive. Three (22.2%) and 20 (83.3%) of the infected mortuary and cemetery workers were asymptomatic, respectively. Age <30 years (OR 4.9, 95% CI 1.7-14.6), community exposure with a known case (OR 4.7, 95% CI 1.7-13.3), and presence of symptoms in the preceding 2 weeks (OR 9.0, 95% CI 1.9-42.0) were independently associated with an increased risk of infection (PCR or antibody positive). Of the 46 environmental and surface samples, all were negative or had a Ct value of >35. CONCLUSION: A substantial proportion of mortuary and cemetery workers had evidence of SARS-CoV-2 infection, which was incidentally detected upon serologic testing. These data are most consistent with community acquisition rather than occupational acquisition.

Estimation of differential occupational risk of COVID-19 by comparing risk factors with case data by occupational group.

BACKGROUND: The disease burden of coronavirus disease 2019 (COVID-19) is not uniform across occupations. Although healthcare workers are well-known to be at increased risk, data for other occupations are lacking. In lieu of this, models have been used to forecast occupational risk using various predictors, but no model heretofore has used data from actual case numbers. This study assesses the differential risk of COVID-19 by occupation using predictors from the Occupational Information Network (O*NET) database and correlating them with case counts published by the Washington State Department of Health to identify workers in individual occupations at highest risk of COVID-19 infection. METHODS: The O*NET database was screened for potential predictors of differential COVID-19 risk by occupation. Case counts delineated by occupational group were obtained from public sources. Prevalence by occupation was estimated and correlated with O*NET data to build a regression model to predict individual occupations at greatest risk. RESULTS: Two variables correlate with case prevalence: disease exposure (r = 0.66; p = 0.001) and physical proximity (r = 0.64; p = 0.002), and predict 47.5% of prevalence variance (p = 0.003) on multiple linear regression analysis. The highest risk occupations are in healthcare, particularly dental, but many nonhealthcare occupations are also vulnerable. CONCLUSIONS: Models can be used to identify workers vulnerable to COVID-19, but predictions are tempered by methodological limitations. Comprehensive data across many states must be collected to adequately guide implementation of occupation-specific interventions in the battle against COVID-19.

A roadmap to the safe practice of forensic medicine in the COVID-19 pandemic.

The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.

[Safe management of COVID-19 dead bodies in sub-Saharan Africa: could families be allowed to bury their dead?] / Gestion sécurisée des dépouilles de personnes décédées de la COVID-19 en Afrique sub-Saharienne: et si on laissait les familles enterrer leurs morts?

Sub-Saharan African countries have been hit by the Coronavirus 2019 pandemic (COVID-19) since March 2020. Besides the resulting health and economic disasters is the psycho-socio-cultural problem related with the management of corpses of people dead from the disease, which might hinder the implementation of the response strategy. In Cameroon for instance, the current corpse management policy is very disputed. In fact, although they were recently made more flexible, the restrictions applied to burials still ban any transfer of dead bodies between cities. In light of the African cultural considerations of dead persons, the disputes observed between the families and the health personnel, the legislation and the available scientific evidence, this article analyses the risks and benefits of allowing families to bury their relatives. It thereafter suggests solutions that reconcile dignity (by allowing families to bury their dead relatives in their homes) and safety (by ensuring a sealed handling and the surveillance by a judiciary police officer). Applying these solutions could improve the population's trust towards the health system, and positively contribute to COVID-19 case prevention, identification and management.

Health Behaviors of Funeral Directors in the US: A Needs Assessment.

Objectives: Little is known about the health-risk behaviors of funeral directors. We undertook a study to examine their health behavior risks by assessing perceived health behaviors. Methods: The study was a cross-sectional, descriptive study of a sample of funeral directors in the US as of September 2018. We used online survey software to disseminate a multi-wave survey to funeral directors. Results: Overall, we received 132 completed surveys (16.5% response rate). Overall, funeral directors rated themselves as healthy, but 61% reported that their mental health was not good in the previous 30 days due to stress, depression, or problems with emotions. We found that 23% reported that their poor physical or mental health keep them from doing their daily activities such as self-care, work, or recreation in the last 30 days. Other behaviors such as screenings, weight management, stress management, and substance use were found to be concerns in this population. Conclusions: Public health efforts should focus on health promotion programming with an emphasis on improving the overall health and well-being of funeral directors in the US.

Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes.

OBJECTIVE: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. METHOD: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem). RESULTS: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. FINAL CONSIDERATIONS: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.

A review of the management and safe handling of bodies in cases involving COVID-19.

Wuhan Municipal Health Commission, China, reported a cluster of cases of 'pneumonia of unknown aetiology' in Wuhan, Hubei province in late 2019. The causative organism was eventually identified as a novel coronavirus. Subsequently, the disease spread to more provinces in China, then the rest of the world, and the World Health Organization declared it a pandemic. The virus was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the disease was termed COVID-19 (Coronavirus disease). Since then, an increasing number of people have succumbed to this infectious disease. High contagiousness and rapid spread of the disease has been a matter of concern, as it may overburden healthcare systems. Hence, it is vital to implement strict infection prevention and control measures to curb the spread of the disease. This article reviews the guidelines available for the handling of bodies of deceased persons with suspected or confirmed COVID-19, and for their safe disposal. It also provides a summary of recommendations for conducting autopsies in cases where COVID-19 is suspected.

A Casa de Máquinas da administração pública no enfrentamento à COVID-19 / La Sala de Máquinas de la administración pública en la lucha contra la COVID-19 / The public administrations engine room in the fight against COVID-19

Resumo O enfrentamento à COVID-19 no Brasil demanda estratégias e ações integradas e articuladas entre as três esferas de governo e seus diversos setores de políticas públicas para prestar serviços públicos essenciais e ofertar programas governamentais emergenciais. Para que essas ações públicas alcancem os cidadãos-usuários, as áreas-meio da administração pública, consideradas - metaforicamente - neste artigo como a Casa de Máquinas, entram em operação. Sob o prisma dessa dimensão intraorganizacional, este trabalho objetiva descrever e analisar as funções administrativas no ajuste do serviço funerário - elo final da cadeia de combate ao coronavírus em qualquer cidade. O locus empírico é o serviço funerário do município de São Paulo, escolhido pela sua magnitude e por ser monopólio do setor público. Usando-se da análise documental e da realização de entrevistas com gestores públicos locais, o artigo joga luz no back office pelas funcionalidades de finanças, recursos humanos, processos e tecnologia da informação (TI), compras e contratos, logística e operações, e comunicação/marketing, evidenciando as engrenagens das organizações públicas no contexto da crise sanitária e contribuindo para a reflexão sobre os pontos-chave que devem ser considerados em distintas realidades, ainda que com as limitações de uma análise de um processo em curso.

Resumen El enfrentamiento a la COVID-19 en Brasil requiere estrategias y acciones integradas y articuladas entre las tres esferas del gobierno y los diversos sectores de políticas públicas para prestar servicios públicos esenciales y ofrecer programas gubernamentales de emergencia. Para que estas acciones públicas lleguen a los ciudadanos-usuarios, las áreas funcionales de la gestión pública, consideradas metafóricamente en este artículo como 'Sala de Máquinas', entran en operación. Bajo el prisma de esta dimensión intraorganizacional, este estudio tiene como objetivo describir y analizar las funciones administrativas en el ajuste del servicio funerario ‒el eslabón final de la cadena de combate al coronavirus en cualquier ciudad‒. El locus empírico es el servicio funerario del municipio de São Paulo, elegido por su magnitud y por ser el monopolio del sector público. A través del análisis documental y de las entrevistas con gestores públicos locales, el artículo arroja luz sobre el back office por las funcionalidades de las finanzas, recursos humanos, procesos y tecnología de la información (TI), compras y contratos, logística y operaciones y comunicación/marketing, destacando los engranajes de las organizaciones públicas en el contexto de la crisis sanitaria y contribuyendo a reflexionar sobre los puntos clave que deben considerarse en diferentes realidades, aunque con las limitaciones de un análisis de un proceso en curso.

Abstract The fight against the COVID-19 pandemic in Brazil requires integrated and coordinated strategies and actions involving different public policy agencies in the local, state, and federal governments, delivering essential services and emergency programs. Such services rely on public administration's functional areas, designated in this work as the "engine room." The study uses this particular intra-organizational dimension to describe and analyze the administrative functions in the adjustment of the death care services in a municipality, as the final link in the fight against the SARS-CoV-2. The empirical locus is the death care service of São Paulo, Brazil. The service was chosen because it is a public sector monopoly and São Paulo because of the municipality's size - one of the biggest in the world. The research adopted documentary analysis and interviews with local public managers, examining the back office of public administration focusing on finance, human resources, processes and information technology, procurement and contracts, logistics and operations, and communication and marketing. The study discusses the mechanisms of public organizations in the context of the pandemic. It leads to a reflection on the key points of such a health crisis considering different realities, recognizing the limits of analyzing an ongoing phenomenon.

Autopsy Services and Emergency Preparedness of a Tertiary Academic Hospital Mortuary for the COVID-19 Public Health Emergency: The Yale Plan.

Pathology Autopsy and Mortuary Services have been front and center in the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) pandemic. The sheer number of fatalities from the pandemic have been unlike any other in recent memory and needed the rapid creation of new protocols and paradigms to manage the situation. This required rapidly escalating mortuary capacity to manage the increased fatalities from the pandemic with the establishment of lines of communication and networking with governmental entities, institution of new policies for patient flow, and implementation of worker infection control and well-being plans. Autopsies also assumed a crucial role, both to provide insight into the pathomechanisms of a novel disease and to allow tissue retrieval necessary to power research directed towards finding a vaccine. We here outline the plan adopted by the Yale Autopsy and Mortuary Services, in alignment with the institutional mission of high-quality patient care, education, research and health care worker safety and well-being, as the Corona Virus Disease of 2019 (COVID-19) pandemic surged in Connecticut. In the early response phase, ensuring sufficient mortuary capacity necessarily took center stage. As we enter the recovery and plateau phase of the pandemic, setting up a process for a rapid and safe autopsy, that will meet educational and research needs while ensuring the safety of our workforce is being implemented.