Outdoor play: A survey of parent's perceptions of their child's safety.

BACKGROUND: Anecdotal reports suggest that parents may be restricting outdoor play in response to a perceived lack of safety and fear of violence and crime in urban environments. The study objective was to determine whether parents who perceived their neighborhood as unsafe would be most likely to restrict their child's outdoor play and report the greatest worries related to neighborhood characteristics. METHODS: A convenience sample of primary caregivers of children aged 5 years to 7 years were recruited from a pediatric primary care center based at an urban academic children's hospital. Study participants completed a 23-question survey available in English and Spanish. RESULTS: Two hundred fifty-four parents completed the survey. Most were English speakers (69%), female (89%), and aged between 21 years and 35 years (76%). Sixty-two percent let their child play outside often or sometimes; whereas 19% reported never allowing their child to play outside. Parents were less likely to allow outside play as their degree of worry increased about traffic (p < 0.0001), rundown parks (p < 0.003), crime (p < 0.0001), witnessing violence (p < 0.0001), being a victim of violence (p < 0.0009), drugs (p < 0.0001), gangs (p < 0.004), and weapons (p < 0.003). Frequency of outdoor play was not correlated with the sex or age of the child or number of children in the family. Spanish speakers were less likely to allow outside play (p < 0.008) but more likely to allow unsupervised play (p < 0.03). CONCLUSIONS: Decreased frequency of outdoor play correlated with increased parental concerns about safety, however, many parents still report allowing outdoor play at least sometimes.

Renal transplant recipients over aged 60 have diminished immune activity and a low risk of rejection.

Strict consideration of the renal transplant candidate's chronologic age is generally supplanted by more subjective reflection on his (her) physiologic state. In the US, patients over 64 years old represented 9.0% of renal transplant recipients in the year 2000, yet little prior experience is available with which to guide the management of geriatric patients. Two hundred and forty six consecutive recipients of primary kidney transplants at the Yale-New Haven Organ Transplant Center between 1990 and 1995 were included in an outcome analysis. Age at transplantation ranged from 2 to 68 years; the study group consisted of the 16 (6.5%) over age 60. The immunosuppressive protocol was uniform for all patients. There was a disproportionately high use of cadaveric organs by older patients; only 1/16 (6.3%) received a living donor kidney. The overall rate of rejection within the first 90 days was 6.7% of cadaveric recipients over 60 versus 37.6% of younger recipients, P=0.001. Actual patient survival rates at 6 years were 100% of patients younger than 11 years versus 69% (11/16) of those older than 60 years. Death censored 5 year graft survival was 100% in older patients versus 85% among the younger patients. The older and younger patients received quantitatively equivalent immunosuppression, but acute rejection was uncommon in the former (6%) versus the younger cohort (34%). It seems logical to consider whether older renal transplant recipients may benefit from a less aggressive immunosuppression strategy.