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PubMed2001

Stigma and rejection: living with AIDS in villages in southern Thailand.

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

Acquired Immunodeficiency Syndrome↗
PubMed1994

A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection. A Swedish survey.

OBJECTIVE: To evaluate people's reactions to procedures involving the dead body by comparing their attitudes toward autopsy, organ donation, and dissection. DESIGN: Survey, using a questionnaire with 24 items that address reactions toward autopsy, organ donation, and donation of the whole body, including religious and sociodemographic issues. PARTICIPANTS: An age-stratified, random sample of 1950 individuals in Sweden, 18 to 75 years old. The response rate was 65%. RESULTS: Eighty-four percent reported acceptance of an autopsy for themselves and 80% for a close relative. Sixty-two percent were willing to donate their own organs and 39% to donate the organs of a family member; 15% accepted donation of their whole body for dissection. Practically all who accepted dissection also were willing to donate their organs and to be autopsied; practically all who were willing to donate their organs also accepted autopsy. About 65% to 70% felt some discomfort at the thought of autopsy and organ donation. Women seemed more sensitive toward operations on the dead body than men. CONCLUSIONS: The rank order of medical procedures after death, based on the proportion of individuals positive toward the procedures, can be used to form a scale with autopsy and dissection at each end point and organ donation in the middle. This scale has the characteristics of a Guttman scale and can be looked on as a comfort-discomfort continuum regarding procedures involving the dead body.

Adolescent↗
PubMed1998

Do doctors read forms? A one-year audit of medical certificates submitted to a crematorium.

To determine the thoroughness and accuracy with which medical certificates for cremation are completed, a record was made, during normal processing of the documents, of the number of questions that were not answered or answered wrongly, or in which clarification was required. Of 835 sets of forms only 346 (41%) were completed sufficiently accurately for the cremation to proceed without further enquiry. Junior doctors contributed the most errors but general practitioners and consultants also contributed large numbers of errors. Doctors ought to be far more accurate and thorough in completing cremation certificates than were those audited here. The results cast doubt on the reliability of information supplied on other forms. In view of the high frequency of poorly completed forms, review by a medical referee remains essential.

Cause of Death↗
PubMed1984

Are we a 'death-denying' society? a sociological review.

There exists in much social science literature on death and dying the traditionally held view that modern societies are 'death-denying'. In some cases this has been a 'throw away' line of minimal importance. Other times, the thesis that we are a death-denying society has taken on the appearance of serious sociological argument. In still other cases, there exists another body of literature which supports this thesis by offering examples of death denial rather than cogent argument. This has amounted to a significant, albeit fragmented, sociological theory of the background of our principle death related behaviours. This paper gives that quasi-theory a systematic review by examining the central terms of reference, argument and examples of 'death denial' in the literature. The main arguments and examples of this thesis, that we are a 'death-denying' society, are evaluated according to their sociological content. Subsequently, the ability of the thesis to explain the principle areas of our death related behaviour as discussed by it, has been assessed. This paper argues that Western societies are not 'death-denying' by any of the major criteria posed in the literature on the subject. To say that our contemporary societies are 'death-denying' has no theoretical or practical explanatory value.

Attitude to Death↗
PubMed1985

How--and why--to request an autopsy.

Autopsy remains the touch-stone of diagnosis, but clinicians are often reluctant to request the procedure because of their discomfort in approaching the family. Fundamental to a successful autopsy request is sensitivity for the family's feelings, which bespeaks respect for the deceased and the family. For example, in announcing the death and requesting autopsy, the clinician should bring the family to the hospital and talk with them privately. If they have questions or reservations about autopsy, the clinician should answer honestly and simply, stressing the benefits of the procedure to the family and society as a whole. Since the manner of request influences the family's decision in about one third of cases, efforts at overcoming personal reluctance in requesting autopsy are worthwhile. Clinical excellence develops through effort and practice in this activity as in any other.

Autopsy↗
PubMed2000

DNA contamination of mortuary instruments and work surfaces: a significant problem in forensic practice?

A study of 20 mortuaries was undertaken to assess whether contamination of instruments, tables and cutting areas due to residual material containing human DNA after routine cleaning is an actual or only a theoretical problem. Of the 20 mortuaries studied, 50% were found to have material containing quantifiable human DNA on the instruments and surfaces sampled. This DNA was amplified and found, in some cases, to have been derived from at least three people. Of those that did not yield measurable amounts of DNA, a number of samples were selected at random, amplified and were found to produce partial profiles indicating the presence of low levels of human DNA. The possible sources of human DNA from mortuaries are discussed as well as means to reduce or irradicate the problem of instrument contamination. Finally the implications of these findings for forensic investigations are discussed.

Autopsy↗
PubMed1990

Mortality of U.S. embalmers and funeral directors.

The causes of mortality of 3,649 white and 397 non-white male U.S. embalmers and funeral directors, who had died between 1975 and 1985, were examined in a proportional mortality study. Non-significant excesses were found for malignancies of the buccal cavity and pharynx (PMR = 120) and for nasopharyngeal cancer (PMR = 216). No sinonasal cancers were observed, while 1.7 were expected. A statistically significant excess of colon cancer (PMR = 127) was found and a non-significant excess of brain and other CNS cancer was noted among whites only (PMR = 123). Statistically significant excesses of malignancies of the lymphatic and hematopoietic systems were found in whites (PMR = 131) and non-whites (PMR = 241). Myeloid leukemia (PMR = 157) and leukemia of other and unspecified cell types (PMR = 228) were in excess, while no excess of lymphatic leukemia was noted. Elevations in risk were also found for non-Hodgkin's lymphoma, polycythemia vera, and myelofibrosis. Non-whites showed a marked excess of multiple myeloma (PMR = 369). Chronic nephritis was in excess among whites (PMR = 215) and non-whites (PMR = 257). No excess of cirrhosis of the liver was found. Excesses of malignancies of the lymphatic and hematopoietic systems could not be directly related to job held in the funeral industry. Further case-control studies are planned to rule out the possibility that the observed associations are artifactual, by assessing the association between specific work practices and disease risk.

Aged↗
PubMed2004

[Cremation--biological source for gender research].

This article presents a project designed for prehistoric gender research. It focuses on the late Bronze Age to early Iron Age urnfield in Cottbus "Alvensleben-Kaserne", Brandenburg. The cremation remains were emptied from the urns layer by layer. This provided excellent conditions for a critical reconstruction of the funeral rituals related to the cremation. Detailed recording of each bone fragment in each layer made possible the discovery of the ritual deposition of burnt bones according to the anatomical order. Cremated bones, a primarily biological source, are also a substantial resource for cultural historical research, e.g., on funeral practices as well as social structures.

Anthropology, Cultural↗
PubMed1980

To answer questions. A review of an autopsy service.

Autopsies are important in the quality control of medical practice, in research, and in teaching. We have attempted to realize more of the service, teaching, and research potential from doing autopsies. The key of all efforts is the involvement of the senior staff. This involvement should be made possible by supporting such a person by a qualified team that consists of the mortuary service, pathologist's assistants, and highly trained and qualified residents. Such a staff person can direct his or her attention toward improving communication with clinicians, answering open questions in-depth, encouraging collaborative clinicopathological projects, developing new approaches to the performance of autopsies, such as the immediate autopsy, and using special laboratory modalities, such as electron microscopy and immunofluorescence. Computer storage of autopsy data and retrieval for special studies seem to make autopsy data available and usable. It is most important that autopsies be performed, that they be done well, and that their findings be carefully evaluated using all available scientific tools and, finally, that the results are adequately communicated.

Autopsy↗
PubMed2006

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Disaster Planning↗
PubMed2003

Nuclear and mitochondrial DNA analysis of a 2,000-year-old necropolis in the Egyin Gol Valley of Mongolia.

DNA was extracted from the skeletal remains of 62 specimens excavated from the Egyin Gol necropolis, in northern Mongolia. This burial site is linked to the Xiongnu period and was used from the 3rd century b.c. to the 2nd century a.d. Three types of genetic markers were used to determine the genetic relationships between individuals buried in the Egyin Gol necropolis. Results from analyses of autosomal and Y chromosome short tandem repeats, as well as mitochondrial DNA, showed close relationships between several specimens and provided additional background information on the social organization within the necropolis as well as the funeral practices of the Xiongnu people. To the best of our knowledge, this is the first study using biparental, paternal, and maternal genetic systems to reconstruct partial genealogies in a protohistoric necropolis.

Alleles↗
PubMed1989

Ethical and legal aspects to death: the burial.

As a form of ritualized behaviour, the burial promotes and maintains the emotional well-being of the individual and the social cohesion of the group. Sources of burial law in Southern Africa are summarized and the present legal situation with regard to burial is given in some detail. Fulton sums up the essence of our subject historically and comparatively as follows: 'Burial of the dead is an ancient practice among men. From paleolithic times to the present, man has responded to the death of his fellow man with solemnity and ceremony. The event of death has evoked not only a religious awe in men, but its threat to the survival of communal life has also engendered fear, just as its disruption of family life has aroused sorrow.'

Attitude to Death↗