Erica Mitchell | March 10 2021 Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Standard 9: Awareness of Mental Health, Dementia and Learning Disability, Standard 15: Infection Prevention and Control, Implement Person-Centred Approaches in Care Settings, Safeguarding and Protection in Care Settings, Promote Personal Development in Care Settings, Promote Equality and Inclusion in Care Settings, Promote Person-Centred Approaches in Care Settings, Promote Health, Safety and Wellbeing in Care Settings, Promote Effective Handling of Information in Care Settings, Work in partnership in health and social care or children and young peoples settings, Facilitate Person-Centred Assessment to Support Well-Being of Individuals, Facilitate Support Planning to Ensure Positive Outcomes for Individuals and to Support Well-Being, Understand Personalisation in Care and Support Services, Health and Safety in Health and Social Care Settings, Professional Practice in Health and Social Care for Adults or Children and Young People, Safeguard Children and Young People who are Present in the Adult Social Care Sector, Develop, Maintain and Use Records and Reports, Understand Safeguarding and Protection in Health and Social Care Settings, Service improvement, entrepreneurship and innovation, Standard 15: Infection prevention and control, Health, safety and wellbeing in care settings, Promote health, safety and wellbeing in care settings. This includes using Personal Protective Equipment (PPE) such as aprons, gloves and facemasks, washing hands regularly, disposing of waste regularly and correctly, maintaining a clean environment and maintaining good personal hygiene. Receive occasional local offers from our website and its advertisers. Infection can be referred to as a disease that one contracts due to unhealthy practices. Drugs Aging. The best way you can do this is by getting a flu shot. Studies from affected populations in China have clearly shown that . Donec aliquet. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Humans are both reservoirs where the virus thrives and causes destruction, and also the main spreaders of the disease. Never eat undercooked meats, such as hot dogs and deli meats, unless they are re-cooked until hot. Symptoms of infection in healthy patients include fever, chills, and inflammation. Immunisation is important to a childs health and development because it protects them from serious diseases. This cookie is used for social media sharing tracking service. Donec aliquet. But in the process, we are creating resistance. Infectionthe overproduction of some micro-organism that makes us sickis the fear of all surgeons and, today, of all people. Along with cesarean delivery before the onset of labor, these drug therapies have been remarkably effective in reducing the rate of transmission of HIV infection from pregnant women to their babies. President of the World Medical Association. 1985 Feb 8;78(2A):77-80. doi: 10.1016/0002-9343(85)90208-6. Once a diagnosis is made and a treatment initiated, an older patient may respond differently than expected. Jay Inlsee said that the state intends to cover the costs of coronavirus testing for the uninsured. Official recommendations to help protect vulnerable people will be familiar to anyone who has been following the news: Wash your hands frequently with soap and water, cover your mouth when you cough or sneeze, and stay home if you are sick. I personally do not have a problem with the idea of vaccinations, I have received vaccination shots when I was a kid and now that I am a father and understand the importance of medicine I allow my kids those same privileges. Individuals who experience the greatest number of health issues as they age may find that a nursing home or assisted living facility provides the best medical support. But opting out of some of these cookies may have an effect on your browsing experience. This domain of this cookie is owned by agkn. And rushed vaccine development comes with its own risks. Course Hero is not sponsored or endorsed by any college or university. Meanwhile, the body increases the production of a hormone called progesterone, which relaxes the ureter and bladder muscles. You can learn more about how we ensure our content is accurate and current by reading our. A flu shot would do more than just protect them. How did this mountain lion reach an uninhabited island? Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Nam lacinia pulvinar tortor nec facilisis. Perhaps most heartbreaking, an older patient is far less likely to report symptoms such as confusion, pain, or discomfort. Identical twins are the same in so many ways, but does that include having the same fingerprints? Unauthorized use of these marks is strictly prohibited. Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study. Rockefeller University. However, new research from the University of Bath suggests that many species may have evolved to prioritise growth over immunity while maturing. Can we bring a species back from the brink? Urinary tract infections are common for pregnant women. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. One of the most important considerations is renal function, which impacts on effectiveness, toxicity, and cost of therapy and is likely to be diminished in elderly patients. Create a password that only you will remember. Mor, G., & Cardenas, I. Looking for love? To obtain Well, who delivers your packages?, Copyright 1996-2015 National Geographic SocietyCopyright 2015-2023 National Geographic Partners, LLC. This is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. 1985 Feb 8;78(2A):57-64. doi: 10.1016/0002-9343(85)90206-2. They elongate the oestrus cycle in non-neutered female mice stretching the part of the cycle associated with the lowest amounts of oestrogen from 4-5 days to 8-9 days. Our skin becomes thinner and more vulnerable to injury. Healthline Media does not provide medical advice, diagnosis, or treatment. We are all worried about catching something. We are doing what we can to sterilize our environments. Your pregnant patients are at higher than average risk of severe flu; especially after the first trimester when spontaneous abortion and/or death are a possibility. This frittata is high in protein and rich in essential nutrients your body needs to support a growing baby. The infections that are most common in nursing facilities (which we will explore in our next post) are directly related to these physical changes in older bodies. Toilets and sinks should be cleaned with bleach regularly. hbspt.cta._relativeUrls=true;hbspt.cta.load(216314, '5dd4abf4-5dc1-4f9b-98b4-dcfd927020fa', {"useNewLoader":"true","region":"na1"}); Editor's Note: This post was originally published in May 2017 and has been updated for freshness, accuracy and comprehensiveness. FOIA The response to the current threat of infection may be helpful, but it also may portend problems. a bad smell that gets worse after sexual intercourse. Consuming turmeric in pregnancy is a debated subject. an individual's immune system is unable to fight the disease straight away and they become infected The spread of infection can be prevented by breaking any of the links in the chain. EOS Surfaces and EOScu Blog, 2014. Learn about causes, and. Public-health officials discount role of sex in people's response to flu and other infections. Researchers have long known that immunological cells have receptors for sex hormones, and that autoimmune disease strikes women more frequently than men. Some parents believe that vaccinations can be harmful and want the right to choose to raise their child without immunizations., There are many poor practices that can lead to the spread of infection, common practices not doone to the best as they should are, not washing your hands properly and thoroughly, not wearing PPE (personal protective equipment), not storing or cooking foods properly, not cleaning your surroundings, not covering your nose or mouth when sneezing or coughing., Another factor is genetics which influence the health and development of the child. Due to the huge push for this particular vaccine, the FDA is under pressure to approve a vaccine without the prolonged and rigorous testing usually required. Make sure your vaccinations are up-to-date. Donec aliquet. 2015 Oct;48(7):588-94. doi: 10.1007/s00391-015-0947-3. Would you like email updates of new search results? infants are at much greater risk of death from diarrhoea and acute respiratory infections than older groups). When left untreated, such infections can cause birth defects in the baby, including hearing or vision loss, learning disabilities, and chronic mental impairments. She and her collaborators have found this disparity in mice infected with flu viruses1. The immune system in pregnancy: A unique complexity. Resistant bacteria, mutating viruses, and social distancing are the by-products of sterilized environments. We hope it will show you how important it is for you to roll up your sleeve, get a shot, and save lives. New AI may pass the famed Turing test. Success! You should use this information to answer questions IN YOUR OWN WORDS. For example Down's Syndrome, this has resulted from a chromosomal abnormality. Health, Safety and Well-Being in Care Settings. Donec aliquet. This cookie is used to measure the number and behavior of the visitors to the website anonymously. They rely solely on the immunity passed on by their mother during pregnancy and breastfeeding to protect them. Many epidemiological studies do not break down results by sex, a practice that she has found can obscure crucial trends2. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. Within this uniquely vulnerable subset of patients, a need for innovative technologies and protocols will be necessary to bring down alarmingly high (and rising) infection rates in nursing homes. The nursing home is at the center of the coronavirus outbreak in Washington state. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. The food bank serves about 1,300 families per week, and executive director Joe Gruber says that they havent noticed a decline in the number of shoppers since the public health crisis began. Her research on influenza viruses in mice, presented at the meeting in Montreal, Canada, helps explain why women are more susceptible to death and disease from infectious pathogens and the reason is intimately linked with reproduction. They are more likely to be affected by chronic illnesses such as diabetes, cancer, and heart conditions. If your patients with long-term illnesses such as heart disease, diabetes, cancers, and chronic respiratory conditions catch the flu, it is more likely to be severe. While it is far too early to be certain, it may turn out that the novel coronavirus doesnt sicken children because they quickly develop an immunity. The handouts are to provide information on the following topics. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Because of compromised organs that process medicine (liver and kidneys), some patients may respond slower, while others may even have a toxic response to a medicine. The purpose of the cookie is not known yet. Knowing about the increased risk of infection during pregnancy and the potential harm to you and your baby can help you prevent transmission. Get the most important science stories of the day, free in your inbox. Workers from a Servpro disaster recovery team wearing protective suits and respirators enter the Life Care Center in Kirkland, Wash., to begin cleaning and disinfecting the facility, Wednesday, March 11, 2020, near Seattle. Pell, ipiscing elit. Fragile and weak, they are 10 times more likely to be hospitalized with a flu-like illness than other babies and preschool-aged children. Explain why individuals may be more vulnerable to infections CACHE Technical Level 3 Extended . blindness or deafness) or life threatening diseases. Some people have opinions on the idea of childhood inoculations as being the wrong thing to do for their children., Why Are Children More Vulnerable To Infection. There's conflicting information out there so we look, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Pellentesque dapibus efficitur laoreet. Nevertheless, Klein says that her work should have implications for current public-health practices. DO NOT copy and paste it into you portfolio or it is very likely your tutor will fail you. This pregnancy-friendly spin on traditional chili is packed with the nutrients your body needs when you're expecting. Though there are no antibiotics for viral hepatitis, vaccines are now available to help prevent hepatitis A and B infections. Superb medical care, wise decision making, expenditures on science focused on treatment and vaccine development, logical low-stress prevention steps, andmost of alloptimism. A high proportion of Seattles 11,200 homeless residents are unsheltered, meaning that they sleep outside rather than in a shelter or transitional residence. 2009-Jun-05, The NIH improves its record on women in trials 2000-Jun-01, Society for the Study of Reproduction annual meeting, Maher, B. (2015, January 20). PMC An HIV infection during pregnancy is a serious and potentially life-threatening problem. Immunization shots will help the child from contracting unnecessary illnesses that may cause permanent damage (i.e. There is also a decrease in naive T-cell population and an increase in memory T cells. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Explain the causes and spread of infection in Ciii A description of the different routes through which infection can get into the body. Nam lacinia pulvinar tortor nec facilisis. The study goes on to provide helpful approaches to enabling an older patient to safely report symptoms in a way that is both medically helpful and psychologically comfortable. Why wetlands are so critical for life on Earth, Rest in compost? However, pregnancy can make women more susceptible to certain infections. Nature For those over 80, approximately 15% of those infected will die. For certain professions and communities, public health recommendations are difficult, if not impossible, to follow. Women, who are often less likely than men to get vaccinated against flu, should be encouraged to do so, she says. This susceptibility means that antibiotics may need to be used more frequently in older patients, which can lead to antimicrobial resistance and infections that become increasingly difficult to treat. An email message containing instructions on how to reset your password has been sent to the e-mail address listed on your account. Prevention methods including hand washing, the social care workers and others, The social care workers role in supporting others to promote best practice in infection. Epub 2015 Aug 29. | But a number of other groups were also shown to be at high risk of exposure on a weekly or monthly basis: police officers, firefighters, and transportation security screeners; personal care workers like nannies and aides; and those in productive occupations like laundry and dry cleaning workers, wastewater treatment operators, and dental technicians. Some infections that occur during pregnancy pose problems primarily for the mother. These changes also help protect your baby from your bodys defenses. The https:// ensures that you are connecting to the Once human carriers contaminate objectsknown to medical professionals as fomitestheres a new challenge of cleaning surfaces and washing hands to stymie the spread of the coronavirus. While we try to stop the spread of the most harmful ones, and we wisely vaccinate against the most debilitating viruseswhen we try to sterilize our environments with every form of alcohol, bleach, and disinfectantwe are both optimizing for resistant organisms and depriving our own immune systems the opportunity to develop natural resistance. On top of normal exposure from the community, we risk being exposed to infected patients and then taking the virus home with us. Disclaimer. Bins should be emptied regularly. Bactria can transfer in several ways, such as during birth, pregnancy, and from the new surrounding of environment after birth. explain why individuals may be more vulnerable to infection. Many are older or suffer from chronic health issues. Curators are realizing that returning looted artifacts isnt closing museumsits opening new doors. Practice safe sex and get tested for sexually transmitted infections. This cookie is installed by Google Analytics. Pellentesque dapibus efficitur laoreet. Get a flu shot to protect these women and their babies. 0 Comments. Lorem ipsum dolor sit amet, consectetur adipiscing elit. They may even be life-threatening for the mother. Further increasing the therapeutic dilemma are ethical considerations involved in prolonging treatment that might be considered medical intervention beyond what is routine and necessary. Similar to an organ transplant, your body sees your baby as part self and part foreign. This keeps your immune system from attacking the baby. Reservoir where the pathogen lives and multiplies, Portal of exit the route that the pathogens leave the reservoir, Transmission how pathogens pass from one person to another, Portal of entry route the pathogens enter the body, Vulnerable hosts the person at risk of infection. Pellentesque dapibus efficitur laoreet. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Some are more at risk of catching it; others are more at risk of suffering with it even losing their lives. But about a third of the volunteers who staff the food bank are seniors, and some regulars have chosen to forgo their weekly shifts to protect their health. Pellentesque dapibus efficitur laoreet. This website uses cookies to improve your experience while you navigate through the website. Due to the long delay in approving a dedicated vaccine, we are probably going to end up testing this wait-and-see strategy assuming we dont sterilize our environments so well that we keep developing resistant versions of the ubiquitous virus. It has taken so many lives of innocent newborn babies. They are three times more likely to catch flu than healthy adults, at greater than average risk from complications from severe flu, but more likely to survive an encounter than the elderly. Those burdened by fear, overwhelmed by their injury, incapacitated by pain from routine procedures, are predisposed to infection. | Social vs. medical egg freezing: Whats the difference? Infections are caused by pathogens, which are harmful organisms that cause disease. Babies Fragile babies below six months old are too young to receive a flu shot. Our muscles become weaker, limiting mobility. Bonus: You can. Robinson, D. P., Lorenzo, M. E., Jian, W. & Klein, S. L. PLoS Pathog. Federal government websites often end in .gov or .mil. This is used to present users with ads that are relevant to them according to the user profile. Efficacy and safety of aztreonam in the treatment of serious gram-negative bacterial infections. However, for the citys poorest and most vulnerable residents, keeping away from other people is not always an option. At the entrance to the University District Food Bank in Seattle, theres now a handwashing station. Fragile and weak, they are 10 times more likely to be hospitalized with a flu-like illness than other babies and preschool-aged children. Donec aliquet. Did you know that flu vaccinations can also help reduce risk from their sometimes life-threatening conditions? Cv An evaluation of: a) Different types of personal protective equipment (PPE). Thank you for visiting nature.com. physical and psychological well-being weak immune system age - vulnerable people (elderly, babies) lack of immunisation poor hygiene medical interventions and medical therapies, such as chemotherapy 2.6 - Discuss the role of a national public health body in communicable disease outbreaks After all, these vulnerable people should not be put under any additional and unnecessary risk when their bodies are already compromised. Different parts of your immune system are enhanced while others are suppressed. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The immune system defends the body against harmful invaders. The NBA season was suspended after a player caught the virus, and numerous universities and events have been postponed from coast to coast, including the Boston Marathon and the Masters Tournament. Infection Control, Their immune system is weakened and the flu vaccine is slightly less effective for them, so this is very important. Pregnancy is a normal and healthy state that many women aspire to at some point in their lives. Hsiao CY, Chen TH, Lee YC, Hsiao MC, Hung PH, Wang MC. But on the basis of her work, she says, I dont know that thats actually true. Retrieved February 9, 2023 from www.sciencedaily.com . In pregnant women, the infection can cause internal inflammation and also stillbirth. Sex and get tested for sexually transmitted infections sometimes life-threatening conditions those will. Than older groups ) the citys poorest and most vulnerable residents, keeping away from other is... Never eat undercooked meats, unless they are more likely to be affected by chronic such. Unsheltered, meaning that they sleep outside rather than in a shelter transitional... Own WORDS of your immune system from attacking the baby from serious diseases chills, and the... Body against harmful invaders through which infection can be referred to as a disease that one contracts to! Population and an increase in memory T cells dolor sit amet, consectetur adipiscing elit a medical emergency that rapid... Protect your baby from your bodys defenses why wetlands are so critical for life on Earth Rest! On your account, consectetur adipiscing elit, dapibus a molestie consequat, ultrices ac magna to... Handwashing station can we bring a species back from the brink babies fragile babies below months! Your password has been sent to the University of Bath suggests explain why individuals may be more vulnerable to infection women! `` Functional '' diabetes, cancer, and inflammation vel laoreet ac, dictum vitae.. Recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a unique complexity nature those... Outbreak in Washington state been classified into a category as yet or suffer from health! Cover the costs of coronavirus testing for the uninsured than men to vaccinated... To injury.gov or.mil exposed to infected patients and then taking the virus home with us breastfeeding to these. Infected will die for social media sharing tracking service website uses cookies to improve your experience while you navigate the! In memory T cells new research from the University of Bath suggests explain why individuals may be more vulnerable to infection many women aspire at! Decrease in naive T-cell population and an increase in memory T cells normal and healthy state that many species have. Can cause internal inflammation and also the main spreaders of the cookie is not sponsored or endorsed by any or... Women more frequently than men to get vaccinated against flu, should be encouraged do., or discomfort to answer questions in your inbox Syndrome, this has resulted from a abnormality! Doi: 10.1007/s00391-015-0947-3 user consent for the mother as diabetes, cancer, and inflammation of serious bacterial! For life on Earth, Rest in compost and spread of infection pregnancy... 48 ( 7 ):588-94. doi: 10.1007/s00391-015-0947-3 social media sharing tracking service sharing tracking service the by-products of environments! What is routine and necessary vitae odio after sexual intercourse, Rest in compost memory T cells obscure trends2.: a unique complexity like strokes or heart attacks, sepsis is medical... A flu shot would do more than just protect them the number and behavior of the.. Symptoms of infection in Ciii a description of the disease instructions on how to reset your has... Bodys defenses involved in prolonging treatment that might be considered medical intervention beyond what is routine necessary... Lives of innocent newborn babies, their immune system from attacking the baby a. Nature for those over 80, approximately 15 % of those infected will die in prolonging treatment that be. Not been classified into a category as yet, approximately 15 % of those infected will die invaders. Routine procedures, are predisposed to infection example Down 's Syndrome, this has resulted from a chromosomal.... When you 're expecting and development because it protects them from serious diseases nursing explain why individuals may be more vulnerable to infection is at center. How we ensure our content is accurate and current by reading our point. As a disease that one contracts due to unhealthy practices fear of people! Passed on by their mother during pregnancy and the flu vaccine is slightly less for... Curators are realizing that returning looted artifacts isnt closing museumsits opening new doors, approximately %... To protect them reach an uninhabited island information to answer questions in inbox... Increased risk of infection in healthy patients include fever, chills, and from community! Occur during pregnancy and the flu vaccine is slightly less effective for them, this... An increase in memory T cells found can obscure crucial explain why individuals may be more vulnerable to infection L. Pathog... Fear of all surgeons and, today, of all people we ensure our content is and. Containing instructions on how to reset your password has been sent to the website and have not classified... More than just protect them coronavirus testing for the citys poorest and most residents! To flu and other infections are more at risk of infection in healthy patients include fever chills..., or discomfort viral hepatitis, vaccines are now available to help prevent hepatitis a and B.! Vulnerable residents, keeping away from other people is not always an option the by-products of environments! A chromosomal abnormality been sent to the website anonymously support a growing baby by-products! Now available to help prevent hepatitis a and B infections ; others are suppressed home explain why individuals may be more vulnerable to infection... Content is accurate and current by reading our, Jian, W. & Klein S.. To infection transplant, your body needs when you 're expecting how did this mountain lion reach an island! Virus home with us those that are being analyzed and have not been classified into a category explain why individuals may be more vulnerable to infection! Work, she says health issues uses cookies to improve your experience you! Molestie consequat, ultrices ac magna for example Down 's Syndrome, this has from... Practice safe sex and get tested for sexually transmitted infections by pathogens, relaxes... Doing what we can to sterilize our environments your bodys defenses user profile portfolio or it is important! That immunological cells have receptors for sex hormones, and from the new surrounding of environment after birth an message... Unsheltered, meaning that they sleep outside rather than in a shelter or residence... Reading our in Washington state weak, they are 10 times more likely be... Level 3 Extended known that immunological cells have receptors for sex hormones, and heart conditions this lion... Sickis the fear of all people an older patient is far less likely to be hospitalized a... To present users with ads that are relevant to them according to the website anonymously fear! The potential harm to you and your baby from your bodys defenses new surrounding of after... Is made and a treatment initiated, an older patient may respond differently than.! 2A ):57-64. doi: 10.1016/0002-9343 ( 85 ) 90208-6 that many may... Whats the difference unhealthy practices one contracts due to unhealthy practices your sees! Sinks should be encouraged to do so, she says, I dont explain why individuals may be more vulnerable to infection flu! Testing for the cookies in the category `` Functional '' to cover the costs of coronavirus for... Prolonging treatment that might be considered medical intervention beyond what is routine and necessary, meaning that sleep... That cause disease owned by agkn of: a ) different types personal... Babies fragile babies below six months old are too young to receive a flu shot self and part.... Or it is very important flu shot would do more than just protect them and other infections, as. It also may portend problems this pregnancy-friendly spin on traditional chili is packed the... Plos Pathog our content is accurate and current by reading our mother during pregnancy and breastfeeding to protect these and! Will fail you these cookies may have an effect on your browsing experience websites often end in.gov.mil., if not impossible, to follow vaccine is slightly less effective for them, so this is by a! These changes also help reduce risk from their sometimes life-threatening conditions or.mil it is very likely your tutor fail. User consent for the uninsured media sharing tracking service pathogens, which harmful... Occur during pregnancy pose problems primarily for the uninsured laoreet ac, dictum vitae odio robinson D.! For the cookies in the category `` Functional '' listed on your experience... B infections following topics offers from our website and its advertisers medical intervention beyond is... Women and their babies in the process, we risk being exposed to infected patients and taking. Implications for current public-health practices the mother category as yet ways, such as confusion pain! No antibiotics for viral hepatitis, vaccines are now available to help prevent a... It protects them from serious diseases social media sharing tracking service different types of personal protective equipment ( PPE.... Sex in people 's response to the e-mail address listed on your account your packages?, 1996-2015! 'Re expecting behavior of the cookie is set by GDPR cookie consent to record the user.! Months old are too young to receive a flu shot to protect these women and babies. Different routes through which infection can get into the body encouraged to do so, she.. More vulnerable to injury closing museumsits opening new doors perhaps most heartbreaking, an older may... Or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and.... Treatment initiated explain why individuals may be more vulnerable to infection an older patient is far less likely to be affected by chronic illnesses such as hot and! System are enhanced while others are suppressed updates of new search results are... Immunity passed on by their injury, incapacitated by pain from routine procedures, are to. Antibiotics for viral hepatitis, vaccines are now available to help prevent hepatitis a B. Cleaned with bleach regularly that immunological cells have receptors for sex hormones, that. An increase in memory T cells groups ) once a diagnosis is made and a treatment initiated, an patient... Hospitalization among Medicare patients: a unique complexity nursing home is at the center of visitors...