Per- and polyfluoroalkyl ether acids in well water and blood serum from private well users residing by a fluorochemical facility near Fayetteville, North Carolina.

BACKGROUND: A fluorochemical facility near Fayetteville, North Carolina, emitted per- and polyfluoroalkyl ether acids (PFEAs), a subgroup of per- and polyfluoroalkyl substances (PFAS), to air. OBJECTIVE: Analyze PFAS in private wells near the facility and in blood from well users to assess relationships between PFEA levels in water and serum. METHODS: In 2019, we recruited private well users into the GenX Exposure Study and collected well water and blood samples. We targeted 26 PFAS (11 PFEAs) in water and 27 PFAS (9 PFEAs) in serum using liquid chromatography-mass spectrometry. We used regression modeling to explore relationships between water and serum PFAS. For the only PFEA detected frequently in water and serum, Nafion byproduct 2, we used generalized estimating equation (GEE) models to assess well water exposure metrics and then adjusted for covariates that may influence Nafion byproduct 2 serum concentrations. RESULTS: We enrolled 153 participants ages 6 and older (median = 56 years) using 84 private wells. Most wells (74%) had ≥6 detectable PFEAs; median ∑PFEAs was 842 ng/L (interquartile range = 197-1760 ng/L). Low molecular weight PFEAs (PMPA, HFPO-DA [GenX], PEPA, PFO2HxA) were frequently detected in well water, had the highest median concentrations, but were not detectable in serum. Nafion byproduct 2 was detected in 73% of wells (median = 14 ng/L) and 56% of serum samples (median = 0.2 ng/mL). Cumulative dose (well concentration × duration at address) was positively associated with Nafion byproduct 2 serum levels and explained the most variability (10%). In the adjusted model, cumulative dose was associated with higher Nafion byproduct 2 serum levels while time outside the home was associated with lower levels. IMPACT: PFAS are a large class of synthetic, fluorinated chemicals. Fluorochemical facilities are important sources of environmental PFAS contamination globally. The fluorochemical industry is producing derivatives of perfluoroalkyl acids, including per- and polyfluoroalkyl ether acids (PFEAs). PFEAs have been detected in various environmental samples but information on PFEA-exposed populations is limited. While serum biomonitoring is often used for PFAS exposure assessment, serum biomarkers were not good measures of long-term exposure to low molecular weight PFEAs in a private well community. Environmental measurements and other approaches besides serum monitoring will be needed to better characterize PFEA exposure.

Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester.

ABSTRACT: The objectives of this Perspective paper are to educate physical therapists on their important role in assessing and treating common pregnancy- and delivery-related health conditions and to advocate for their routine inclusion in postpartum care during the fourth trimester. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are 2 examples of musculoskeletal disorders associated with pregnancy and childbirth that can have negative physical, social, and psychological consequences. This paper reviews evidence from 2010 through 2021 to discuss the efficacy of physical therapist intervention in the fourth trimester for PFD and DRA. The role of physical therapy in the United States is compared with its role in other developed nations, with the intent of illustrating the potential importance of physical therapy in postpartum care. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for PFD and DRA; however, physical therapists in the United States currently have a peripheral role in providing postpartum care. Lack of awareness, social stigma, and policy barriers prevent women from receiving physical therapist care. Recommendations are made regarding ways in which physical therapists can increase their involvement in the fourth trimester within their community, stimulate policy change, and promote improved postpartum care practices. IMPACT: This Perspective highlights the valuable role of physical therapist assessment and treatment during the postpartum period for some common musculoskeletal conditions associated with pregnancy and delivery.