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BACKGROUND
Propionic acidemia is an inherited disorder caused by deficiency of propionyl-CoA carboxylase. Although it is one of the most frequent organic acidurias, information on the outcome of affected individuals is still limited.
STUDY DESIGN/METHODS
Clinical and outcome data of 55 patients with propionic acidemia from 16 European metabolic centers were evaluated retrospectively. 35 patients were diagnosed by selective metabolic screening while 20 patients were identified by newborn screening. Endocrine parameters and bone age were evaluated. In addition, IQ testing was performed and the patients' and their families' quality of life was assessed.
RESULTS
The vast majority of patients (>85%) presented with metabolic decompensation in the neonatal period. Asymptomatic individuals were the exception. About three quarters of the study population was mentally retarded, median IQ was 55. Apart from neurologic symptoms, complications comprised hematologic abnormalities, cardiac diseases, feeding problems and impaired growth. Most patients considered their quality of life high. However, according to the parents' point of view psychic problems were four times more common in propionic acidemia patients than in healthy controls.
CONCLUSION
Our data show that the outcome of propionic acidemia is still unfavourable, in spite of improved clinical management. Many patients develop long-term complications affecting different organ systems. Impairment of neurocognitive development is of special concern. Nevertheless, self-assessment of quality of life of the patients and their parents yielded rather positive results.
Climate change is having drastic effects on various areas of the planet, including extreme impacts on weather and rainfall, in various Sub-Saharan East African countries (Hendrix, C. S., & Glaser, S. M. (2007). The willingness (and need) of a niche market to actively improve the damaged ecosystems in small ways is rising. Weaver and Lawton (2007, p 1170) maintain that ecotourism should satisfy three core criteria: "(1) attractions should be predominantly nature-based; (2) visitor interactions with those attractions should be focused on learning or education, and (3) experience and product management should follow principles and practices associated with ecological, socio-cultural and economic sustainability." In this study, the niche market of active German "tree-planters" is to be defined and the potential willingness to travel to, learn from and invest in the ecosystem through tree-planting, specifically in Kenya, is explored.