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Objective To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. Design Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. Results Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. Conclusions The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience., OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

Objective To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. Design Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. Results Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. Conclusions The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience., OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

Objective:When the COVID-19 pandemic reached Norway, primary health care had to reorgan-ize to ensure safe patient treatment and maintain infection control. General practitioners (GPs)are key health care providers in the municipalities. Our aim was to explore the experiences andmanagement strategies of Norwegian GPs during the COVID-19 pandemic - over time, and inthe context of a sudden organizational change.Design:Longitudinal qualitative interview study with two interview rounds. The first round of inter-views was conducted from September–December 2020, the second round from January–April 2021.In the first interview round, we performed eight semi-structured interviews with GPs from eightmunicipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutiveinterviews were performed 2–4 months apart. To analyze the data, we used thematic analysis.Results:The COVID-19 pandemic required GPs to balance several concerns, such as continuityof care and their own professional efforts. Several GPs experienced challenges in the collabor-ation with the municipality and in relation to defining their own professional position. Guidedby The Norwegian Association of General practitioners, The Norwegian College of GeneralPractice and collegial support, they found viable solutions and ended up with a feeling of hav-ing adapted to a new normal.Conclusions:Although our study demonstrates that the GPs adapted to the changing condi-tions, the current municipal health care models are not ideal. There is a need for clarification ofresponsibilities between GPs and the municipality to facilitate a more coordinated future pan-demic response.

Objective:When the COVID-19 pandemic reached Norway, primary health care had to reorgan-ize to ensure safe patient treatment and maintain infection control. General practitioners (GPs)are key health care providers in the municipalities. Our aim was to explore the experiences andmanagement strategies of Norwegian GPs during the COVID-19 pandemic - over time, and inthe context of a sudden organizational change.Design:Longitudinal qualitative interview study with two interview rounds. The first round of inter-views was conducted from September–December 2020, the second round from January–April 2021.In the first interview round, we performed eight semi-structured interviews with GPs from eightmunicipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutiveinterviews were performed 2–4 months apart. To analyze the data, we used thematic analysis.Results:The COVID-19 pandemic required GPs to balance several concerns, such as continuityof care and their own professional efforts. Several GPs experienced challenges in the collabor-ation with the municipality and in relation to defining their own professional position. Guidedby The Norwegian Association of General practitioners, The Norwegian College of GeneralPractice and collegial support, they found viable solutions and ended up with a feeling of hav-ing adapted to a new normal.Conclusions:Although our study demonstrates that the GPs adapted to the changing condi-tions, the current municipal health care models are not ideal. There is a need for clarification ofresponsibilities between GPs and the municipality to facilitate a more coordinated future pan-demic response.

Halvor Naess,1 Lene Lunde,2 Jan Brogger11Department of Neurology, Haukeland University Hospital, 2Department of Economics, University of Bergen, Bergen, NorwayBackground: Many patients with cerebral infarction suffer from symptoms such as pain, fatigue, and depression. The aim of this study was to evaluate these symptoms in relation to health-related quality of life (HRQoL) on long-term follow-up.Materials and methods: All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, Norway between February 2006 and November 2008 were sent a questionnaire, including a visual analog pain scale, Fatigue Severity Scale, Depression Subscale of Hospital Anxiety and Depression Scale, Barthel Index, and three measures of HRQoL – 15D, EuroQol, and EuroQol Visual Analogue Scale – at least 6 months after stroke onset. Cox regression survival analysis, including EQ-5D, was performed by November 2009.Results: The questionnaire was returned by 328 patients. All three symptoms were reported by 10.1% of the patients, and 26% reported two symptoms. There was a significant association between worse HRQoL scores and an increasing number of cooccurring symptoms for all three HRQoL scores. Fatigue, depression, pain, functional state, and sleeping disorder on follow-up accounted for 58%–83% of the variability in HRQoL, depending on which HRQoL scale was used. Cox regression analysis showed that mortality was associated with a low EuroQol score (P = 0.016).Conclusion: Pain, fatigue, and depression were common symptoms among these stroke patients and, to a large extent, they determined the patients' HRQoL. Low HRQoL was associated with increased mortality.Keywords: cerebral infarction, symptoms, mortality