FARGO, N.D. - North Dakota is among the states leading the way in making sure stroke victims are getting the fastest and best treatment possible. Stroke is still one of the leading causes of death in the nation, but continues to slide down the rankings, and the American Heart Association credits North Dakota as part of that improvement.

That's because the state has 80 percent of its hospitals in what's called a Stroke Registry, and Beth Ashmore, senior director of ambulatory services with the Essentia Health organization, says that's the highest rate in the nation.

"All six of the tertiary hospitals in North Dakota, and 26 out of the 36 critical-access hospitals, actively share and participate in the Stroke Registry."

She says hospitals in the program are provided with proven treatment plans, and outcomes are tracked so they can continue to improve treatment for stroke victims.

Ashmore says support of the North Dakota Legislature for the stroke registry and task force has been critical to the program's success since it began in 2009.

She adds that one component of that success is giving hospitals treatment guidelines to improve the continuity and standards of care for stroke victims.

"And it also tracks the performance. Hospitals can then identify areas for process redesign and what needs to be worked on to continually improve the care."

Another focus is educating the public about the warning signs of a stroke. They include confusion or dizziness, trouble speaking or seeing, and sudden numbness in the face, arm or leg.

Ashmore says if you have these symptoms or see them in another person, call 911, because with a stroke, time is critical.

"It's really a blood vessel that's being blocked by a clot, so really, fast diagnosis and treatment can make the difference between returning to a life of independence with minimal side effects, versus one of disability."

Ashmore says it's important to note the time that symptoms begin, because a key clot-busting drug called TPA can only be administered generally in the first three or four hours after onset.

The other key focus of the Stroke Registry is to let people know there are many ways to reduce stroke risk.

"Manage and control your blood pressure. You really want to know your cholesterol numbers. Manage your diabetes. Stop smoking and avoid second-hand smoke. Be active for 30 minutes a day, and really eat healthy. Maintain a healthy weight, looking at aiming for a diet with less than a 1500 milligrams of sodium per day."

Nationally, stroke has dropped from third to fourth as the leading cause of death, while in North Dakota, it has dropped to sixth.

More information is at www.ndhealth.gov




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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added once the bill is passed, the state can build on it by allowing people to earn additional time off, at least up to 40 hours. It stems from the pandemic, when people had to isolate for up to five days if they contracted COVID-19, which could burn through their allotted sick time.


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