Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry.

PURPOSE: Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure. MATERIALS AND METHODS: Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors' cuffs to a central database using the Medistance system of Omron. RESULTS: Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05). CONCLUSION: In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.

What is the background?The standard method for the diagnosis of hypertension and for the control of treatment efficacy in hypertensive patients is office blood pressure measurement.Until now we had no real-life data on the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists.Although seasonal differences in blood pressure values are well known, we had no data on the extent of these changes.What is new?In this real-world, nationwide observational study we were able to measure the frequency of blood pressure measurements in the daily practice of GPs, internists and cardiologists in Hungary, which was found to be very low compared to the number of patients they treat. In practices with more patients, blood pressure is generally less well-controlled.We could also detect a significant seasonal variation in systolic and diastolic blood pressure values over the observed time periods.What is the impact?The low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians, supporting the further promotion of home blood pressure measurement.The marked seasonal blood pressure changes demonstrated by our study require attention and the individual adjustment of treatment in different seasons.

Higher level of physical activity reduces mental and neurological symptoms during and two years after COVID-19 infection in young women.

Previous studies found that regular physical activity (PA) can lower the risk of SARS-CoV-2 (COVID-19) infection and post-COVID-19 condition (PCC), yet its specific effects in young women have not yet been investigated. Thus, we aimed to examine whether regular physical activity reduces the number of symptoms during and after COVID-19 infection among young women aged between 18 and 34 (N = 802), in which the confounding effect of other morbidities could be excluded. The average time since infection was 23.5 months. Participants were classified into low, moderate, and high PA categories based on the reported minutes per week of moderate and vigorous PA. Using the Post-COVID-19 Case Report Form, 50 different symptoms were assessed. Although regular PA did not decrease the prevalence of COVID-19 infection and PCC but significantly reduced the number of mental and neurological symptoms both in acute COVID-19 and PCC. Importantly, the high level of PA had a greater impact on health improvements. In addition, the rate of reinfection decreased with an increased level of PA. In conclusion, a higher level of regular PA can reduce the risk of reinfection and the number of mental and neurological symptoms in PCC underlying the importance of regular PA, even in this and likely other viral disease conditions.

Organizational development and management factors involved in the prevention and effective therapy of pressure ulcers: The results of the national survey conducted among Hungarian public hospitals.

The prevention of pressure ulcer (PU) or pressure injury (PI) wounds is of public health importance in developed countries, including Hungary. The study aimed to assess the PU/PI prevention and care practices of Hungarian public hospitals and identify organizational and management factors. In 2022, a national, questionnaire-based survey of inpatient institutions relevant to PU/PI care was conducted, providing a picture of the practices of 86 hospitals for the year 2019. The questionnaire was processed using descriptive statistics and regression analysis. The survey results show that good practices in Hungary are isolated, the reporting system is inhomogeneous, and documentation is not uniform across our institutional system. Of the 86 institutions, 71.0% operate a PU prevention team, 64.0% use prophylactic dressings, and 88.3% use an anti-decubitus mattress, with an average ratio of 26.1% to the number of beds. Less than half of the institutions reported the incidence of hospital acquired pressure injuries (HAPIs). In this sample, we found no significant association between hospital type and hospital size with the incidence of full-thickness HAPIs (stage III and IV wounds). Developing a comprehensive PU/PI reporting system and updating the national PU/PI prevention and care guidelines are essential in Hungary.

Thyroid disturbances after COVID-19 and the effect of vaccination in children: a prospective tri-center registry analysis.

Rapidly evolving clinical data suggest that the novel coronavirus (SARS-CoV-2) and vaccination against COVID-19 might be associated with thyroid disturbances. However, studies remain limited among the pediatric population. Our aim was to assess the prevalence and permanence of thyroid autoimmunity (TA) and dysfunction in children after an acute infection and its potential association with vaccination. A prospective, multicenter registry analysis was performed among 458 children (mean age: 12.4 ± 3,8 years, 45.4% male) with preceding COVID-19. Patient inclusion lasted from 24th March, 2021 to 23rd March, 2022 at three pediatric outpatient facilities at Semmelweis University, Budapest. Primary outcomes were the rate of thyroid disturbances assessed by laboratory parameters (thyroid function tests, antithyroglobulin [ATG] and anti-thyroid peroxidase [ATPO] antibodies) and thyroid ultrasound. TA rate among vaccinated and unvaccinated children was determined. Children with newly diagnosed thyroid alterations were followed up for 12.7 ± 4.3 months. Six children had previous thyroid disease. Out of 452 children, 30 cases (6.6%) of newly diagnosed TA (six of them had abnormal thyroid-stimulating hormone [TSH] levels) and eight cases (1.8%) of isolated TSH elevation were observed. Ultrasound-proven autoimmune thyroiditis (AIT) was 4.0%. No association was found between COVID-19 vaccination and thyroid autoimmunity (χ2(1,N = 452) = 0.138, p = 0.815). Among children with TA, 73.3% had long-lasting alterations.  Conclusion: Vaccination had no effect on the prevalence of TA. Until further controlled studies state otherwise, children with preceding COVID-19 might benefit from thyroid screening. What is Known: • Numerous case reports implicate that coronavirus disease-2019 (COVID-19) and vaccination against SARS-CoV-2 can be responsible for thyroid disturbances. • Thyroid alterations discovered during acute COVID-19 tend to cease by time and only incidental thyroid autoimmunity (TA) is diagnosed after COVID-19. In adults, no increase in vaccine-related hyper- or hypothyroidism was found. What is New: • TA rate after COVID-19 vaccination among children was not increased. TA had no role in long COVID syndrome. • We discovered a considerable rate of TA (6.6%) and ultrasound-proven autoimmune thyroiditis (AIT) (4.0%) after SARS-CoV-2 infection, and the majority of these alterations remained positive after 6 months.

A large sample cross-sectional study on mental health challenges among adolescents and young adults during the COVID-19 pandemic at-risk group for loneliness and hopelessness during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has posed unprecedented challenges for societies. Emerging data have indicated that the younger population are the most vulnerable group to the development of mental health problems during this pandemic. The present study aimed to examine the effects of the changes in health behaviors on mental health problems to identify an at-risk group among adolescents and young adults. METHODS: In the present cross-sectional study, secondary school students (N = 2556) ages 15-21 years participated in Hungary. A self-report questionnaire was developed to measure the changes in health behaviors. Mental health problems were measured by the Beck Hopelessness Scale and the 20-item UCLA Loneliness Scale. RESULTS: A significant proportion of the students showed moderate/severe hopelessness or high loneliness which were more pronounced among adolescent females. An at-risk group was identified among adolescents and young adults. Students who have a lower number of friends, spend less time in front of a screen, and feel lonely often/very often are more likely to have moderate/severe hopelessness with high loneliness. LIMITATIONS: All data were collected online, and students completed the questionnaires voluntarily. Cross-sectional, non-preregistered study. CONCLUSIONS: Loneliness and hopelessness were prevalent in the young population during the COVID-19 pandemic. The at-risk group of adolescents characterized by moderate/severe hopelessness with high loneliness highlights the need for follow-up mental health to avoid future poor mental and physical health. It is also recommended to develop effective interventions targeted to gender and age, with the promotion of resiliencies and buffers against vulnerabilities of negative life events.

The Effects of a Cyberbullying Intervention Programme Among Primary School Students.

Background: With the increase of cyberbullying, several intervention programmes have been created that aim at reducing cyber-victimisation and perpetration. Objective: Our study presents the effects of the STAnD anti-cyberbullying programme with peer-education both on the short and the long run among lower and upper primary school students, with a focus on the participants' cyberbullying roles. Method: The sample comprised of 536 students who participated in the intervention programme, involving 36% lower and 64% upper primary school students. Participants were measured by a self-reported questionnaire before and right after the programme, then six months later. Results: The main effect of the STAnD programme was a positive change in the participants' willingness to engage in help-seeking and their active-defending reaction, although this effect decreased after six months. The changes were larger among lower primary school students compared to upper primary school participants. Conclusion: Our results imply that long-lasting and intensive health promotion programmes are necessary to reach a long-term intervention effect. Anti-cyberbullying programmes should take into consideration participants' involvement and roles in cyberbullying. As our study was a non-randomised uncontrolled study design, thus interpretation of the effectiveness of the programme is limited. Supplementary Information: The online version contains supplementary material available at 10.1007/s10566-022-09714-9.

Clinical assessment of children with long COVID syndrome.

BACKGROUND: There is a need for further understanding pediatric long COVID syndrome (LCS) to be able to create specific case definitions and guidelines for providing good clinical care. METHODS: Medical records of all LCS patients who presented at our designated LC clinic were collected. We carried out descriptive analyses summarizing the history, clinical presentation, and findings of children, while doing a diagnosis of exclusion with multi-disciplinary medical examinations (physical, laboratory, and radiological examinations, specialist consultations, etc.) without a control group. RESULTS: Most children reported at least minor impairment to their quality of life, of which 17 (23%) had moderate or severe difficulties. Findings that could be directly connected to the linked complaint category were observed in an average of 18%, respiratory symptoms with objective alterations being the most frequent (37%). Despite our detecting mostly non-specific conditions, in a smaller number we identified well-described causes such as autoimmune thyroiditis (7%). CONCLUSIONS: The majority of children stated an impairment in their quality of life, while symptom-related conditions were detected only in a minority. Controlled studies are needed to separate the effect of the pandemic era from the infection itself. Evidence-based pediatric guidelines could aid to rationalize the list of recommended examinations. IMPACT: Long COVID syndrome is a complex entity with a great impact on children's everyday lives. Still, there is no clear guidance for pediatric clinical management. Systematic, detailed studies with medical assessment findings could aid the process of creating evidence-based guidelines. We present validated systematic information collected during in-person medical assessments with detailed medical findings and quality of life changes. While making a diagnosis of exclusion, we could confirm symptom-related conditions only in a minority of children; however, the majority reported at least minor impairment to their quality of life.

Screening attendance disparities among Hungarian-speaking Roma and non-Roma women in central and eastern European countries.

The Roma populations in Central and Eastern Europe are two to three times more likely to have unmet health needs compared to non-Roma residents. The aim of the present study was to investigate the disparity in screening attendance between Hungarian-speaking Roma (R) and non-Roma (nR) women in Hungary (HU-R:322; nR:294), Romania (RO-R:258; nR:183), and Slovakia (SK-R:146; nR:163), while also identifying the factors that influence attendance at any kind of screening tests in both populations. In order to examine these factors, a multiple binary logistic regression was conducted. The findings revealed significant associations between attendance at any kind of screening tests and certain factors among different groups. Among Hungarian Roma women, it was found that having a chronic disease and smoking were linked to attendance at any kind of screening tests (p = 0.009). Specifically, having a chronic disease increased the odds of attendance (OR = 1.71 [1.01, 2.90]), while smoking decreased the odds (OR = 0.57[0.365, 0.91]). In Romania, the study found that not having health insurance decreased the odds of attendance among Roma women (OR = 0.50 [0.27, 0.91]), whereas having a chronic disease increased the odds (OR = 2.87 [1.44, 5.72]) (p = 0.006). Among non-Roma women in Romania, physical inactivity was associated with a decreased likelihood of attendance at any kind of screening tests (OR = 0.48 [0.25, 0.95]). Among Slovakian Roma women, not having health insurance (OR = 0.09[0.02, 0.36]) and smoking (OR = 0.25[0.11, 0.61]) were found to decrease the odds of attendance (p < 0.001). On the other hand, non-Roma women in Slovakia with chronic diseases were more likely to attend at any kind of screening tests (OR = 2.52[1.12, 5.66]). Our research emphasizes the impact of lacking health insurance on screening attendance, particularly among the Roma population. It also highlights the significance of health-related behaviours such as smoking and physical inactivity in relation to missed screening tests, which in turn contribute to the development of non-communicable diseases. Therefore, promoting targeted screening programs for the Roma community is crucial to ensure their access to screening tests, especially in cases of chronic illnesses.

Assessing physical activity and subjective health status among Hungarian secondary school students during the distance learning period caused by the COVID-19 pandemic / A fizikai aktivitás és a szubjektív egészségi állapot értékelése magyar középiskolások körében a COVID-19-pandémia okán elrendelt távoktatási idoszakban

Introduction: High school education took place in the form of distance learning during SARS-CoV-2 pandemic worldwide, including Hungary. Decreased physical activity and an increase in inactive behaviours may lead to an increased risk of obesity, diabetes, and cardiovascular disease. Objective: Our study focused on changes in physical activity (aerobic exercise, muscle strengthening, team sports) and subjective perceptions of health status in adolescents and young adults during the pandemic. Method: High school students in 66 public schools in 37 cities in Hungary (n = 2508) were surveyed. Questionnaire items on physical activity and subjective perceptions of health were adapted from the WHO Health Behaviour of School-aged Children Survey and the Centers for Disease Control and Prevention Youth Risk Behavior Survey. 2 x 2 x 4 factorial ANCOVA was used to test the effect of gender and/or age and region on changes in subjective perceptions of physical activity and health before and during distance education. Results: The majority of the high school students reported a decrease in physical activity frequency during the distance learning period, with an average of 2-3 fewer days of physical activity per week regardless of region. Nearly a quarter of them rated their health as worse during distance learning than before. A higher proportion of those who reported a subjective decline in health also reported a decline in physical activity. Conclusion: A decline in physical activity during the period of distance learning is associated with a decline in subjective perceptions of health, especially among rural adolescent girls.

Physical Activity and Screen Time among Hungarian High School Students during the COVID-19 Pandemic Caused Distance Education Period.

BACKGROUND: High school education took place in the form of distance learning during SARS-CoV-2 pandemic worldwide, including Hungary. Decreased physical activity and an increase in inactive behaviours may lead to an increased risk of obesity, diabetes, and cardiovascular disease. AIM: Our study targeted changes in physical activity (aerobic exercise, muscle strengthening) and screen time in adolescents and young adults during the pandemic. METHODS: High school students were interviewed in 66 public schools in 37 Hungarian cities (N = 2508). Survey items on physical activity and screen time were derived from the WHO Health Behaviour of School-aged Children Survey and the Centers for Disease Control Youth Risk Behavior Survey. A 2 × 2 factorial ANCOVA was used to test the effects of gender (male vs. female) and/or age (adolescents vs. young adults) on the reported changes in physical activity and screen time before and during lockdown (covariate: BMI Z-score). RESULTS: The majority of the cohort indicated less physical activity. Aerobic and muscle-strengthening type of exercises significantly decreased, and screen time increased during distance education. Male individuals showed a higher decrease in the level of aerobic exercise, and young adults reported a higher increase in the time spent in front of the screen.

[Treatment of De Quervain's tendinopathy with conservative methods]. / A De Quervain-féle tendinopathia kezelése konzervatív módszerekkel.

Introduction: De Quervain's tendinopathy affects the region of the wrist and the hand. Thumb motion becomes painful. This illness is caused by a degenerative process rather than inflammation. Primary treatment methods are splinting, taking non-steroid anti-inflammatory drugs and different physical therapeutic modalities, administration of a steroid injection into the tendon sheath or surgical release of the tendon sheath may be performed. Aim: The aim of the present study was to investigate whether conservative treatment complemented by eccentric training could provide an adequate alternative to the currently accepted treatment options. Method: The eccentric training lasted for 8 weeks (if necessary for 12 weeks). Following the introduction to exercises, patients (n = 9) repeated the training several times a day, which was controlled during weekly meetings. At the 1st, 8th and 12th meetings, inspection and the following measurements were performed: range of motion, muscle strength, evaluation and number of painful regions including the completion of patient questionnaires. Data were analysed with paired samples t-tests and repeated measures ANOVA. IBM SPSS Statistics 25.0 and Microsoft Office Excel Professional Plus 2016 programs were used. Results were regarded significant at level of p<0.05. Results: Significant improvements were found in the intensity of pain (Numeric Pain Rating Scale p = 0.005, n = 9) and in the functionality of the hand and wrist (Quick Disabilities of the Arm, Shoulder and Hand questionnaire part 1. p<0.001, part 2. p<0.001, Patient-Rated Wrist Evaluation questionnaire p<0.001; n = 9). Conclusion: With careful patient selection, conservative treatment complemented by eccentric training could be an alternative to current treatment options. Orv Hetil. 2020; 161(11): 419-424.

[The role of regular physical activity in the prevention and intervention of symptoms of anxiety and anxiety disorders].

Anxiety disorders are the most common mental illness, but are not uniform, many clinical diagnoses include the symptoms of anxiety. That is the reason why there are relatively small numbers of population surveys and randomized-controlled trials which have examined the relationship between exercise and the various anxiety symptoms/ disorders. In our review we summarize meta-analytic studies, epidemiological surveys and randomized controlled studies which examine the role of regular physical activity in the prevention and treatment of subclinical anxiety/anxiety symptoms and anxiety disorders. The meta-analytic studies and randomized-controlled trials examining the relationship between subclinical anxiety disorders and anxiety symptoms demonstrated small to moderate effect of exercise in the decrease of anxiety symptoms, especially for moderate-intensity exercise. This relationship was confirmed for both acute and chronic exercise, for state and trait anxiety in different sex, age and state of health groups. In the case of the anxiety disorders based on reviewed studies, we can conclude that there is a potential association between decreased symptoms of anxiety and exercise. The regular, moderate-intensity exercise can reduce and alleviate the symptoms of anxiety - at least in panic, agoraphobia and generalized anxiety disorders. The reviewed studies have been highlighted the fact, that exercise can be effective in psychiatric practice as an alternative or adjuvant therapy. Physically healthy people with anxiety symptoms, or patients with anxiety disorders can perform exercise, there are no contraindications. Although based on previous studies, we cannot assume that the relationship is causal, but we cannot ignore the evidences that are already available.

Reliability and validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN): comparing psychiatric patients with control subjects.

PURPOSE: The Pittsburgh Sleep Quality Index is used to evaluate subjective sleep quality, and it is commonly used in clinical research. Subjective sleep quality is also an important clinical measure in patients with psychiatric disorders. The aim of the present study was to evaluate the reliability and validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN) in both clinical and non-clinical samples. METHODS: The original version of PSQI was translated into Hungarian according to standard guidelines. The PSQI-HUN and the Athens Insomnia Scale (AIS) were subsequently administered to 53 psychiatric patients (schizophrenia, recurrent depressive disorder, mixed anxiety, and depressive disorder) and 178 healthy controls. RESULTS: Internal consistency as measured by Cronbach's alpha in the whole sample was 0.79. Pearson's product-moment correlations between component scores and the global scores were high (0.59-0.88) in the PSQI-HUN indicating the homogeneity of the scale. PSQI-HUN global and component scores differed significantly between psychiatric patients and control subjects. In the psychiatric patient subsample, schizophrenics had lower global scores compared to the other two patient groups. The analysis of convergent validity showed significant correlations between the AIS and the global as well as the component scores of the PSQI-HUN (except the component of sleep latency). CONCLUSIONS: The present study concludes that the PSQI-HUN is a reliable, valid, and standardized measure for assessment of the subjective sleep quality in clinical and research settings.

Diagnosis of primary insomnia by actigraphy--improved results by data selection.

STUDY OBJECTIVES: In spite of the useful information provided by actigraphy in sleep medicine it is still not an independent tool either in the clinical diagnosis or in the follow-up. In the frame of a retrospective study, a simple new method of data reduction was applied with the aim of improving the clinical impact of actigraphy for the diagnosis of primary insomnia. METHODS: Actigraphic records with a duration of 1 week produced on 47 subjects who met the inclusion-exclusion criteria. The daily activities during the investigational period were registered by means a self-completed questionnaire. Three parameters (sleep latency, sleep fragmentation and sleep efficiency) and only their three 'worse - as regards insomnia' daily values were analyzed statistically. The study participants comprised 13 healthy controls, 17 healthy 'bad sleepers' and 17 subjects with primary insomnia. RESULTS: The post-hoc tests did not reveal statistically significant difference in the three parameters between the healthy and 'bad sleeper' groups, but these two groups differed statistically from the primary insomnia group. CONCLUSION: The actigraphic analysis of sleep latency, sleep fragmentation and sleep efficacy allows a significant differentiation between subjects with primary insomnia and healthy controls, but not between healthy controls and healthy 'bad sleepers'. Statistical algorithms indicated 'models' for clinically good and bad sleepers. Further studies on large populations are necessary before this method can be introduced in the routine medical care of individuals with primary insomnia.

[Regular physical activity and mental health. The role of exercise in the prevention of, and intervention in depressive disorders]. / Rendszeres fizkai aktivitás és mentális egészség. A testmozgás szerepe a depresszió megelozésében és kezelésében.

In our review we examine the relationship between physical activity and mental health; especially we determine the effectiveness of exercise in the prevention and treatment of depression. Over the past two decades the literature in the area of physical activity and mental health has been growing. However it seems that the findings and evidences not being utilized by mental health agencies and health practitioners. Depression is the most common disorder in the world, generally has a higher prevalence among women. In our study we overview and demonstrate that the exercise is a powerful intervention for prevention and treatment not only in non-clinical but also in clinical levels of depression. In sub-clinical levels of depression the meta-analytic findings and population surveys suggest that the exercise is associated with a significant moderate reduction of depression in different groups by gender and age; as well as a physically active lifestyle associates with lower levels of depression. In clinical levels of depression the physical activity is an effective tool in the prevention, studies support an association between higher levels of physical activity and lower levels of depression. In the treatment of clinical depression the randomized-controlled trials suggest the clear positive effects of exercise. This effect is similar to psychotherapeutic interventions and it was appeared under relatively short time (4-8 weeks). The exercise is one of the most important preventive health-related behaviors. Our review suggests a protective effect from activity on the development of clinical levels of depression and depressive symptoms. In addition the randomized controlled trials support a causal connection between exercise and reduction of depression. In sum the reviewed studies clearly support the antidepressant effect of exercise.

Music improves sleep quality in students.

AIM: This paper is a report of a study to investigate the effects of music on sleep quality in young participants with poor sleep. BACKGROUND: Sleep disorders may result in fatigue, tiredness, depression and problems in daytime functioning. Music can reduce sympathetic nervous system activity, decrease anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation and distraction from thoughts. Control groups have not been used in most previous studies. METHODS: We used a three-group repeated measures design. Ninety-four students (aged between 19 and 28 years) with sleep complaints were studied in 2006. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audiobook (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. RESULTS: Repeated measures anova revealed a main effect of TIME (P < 0.0001) and an interaction between TIME and GROUPS (P < 0.0001). Post hoc tests with Bonferroni correction showed that music statistically significantly improved sleep quality (P < 0.0001). Sleep quality did not improve statistically significantly in the audiobook and the control group. Depressive symptoms decreased statistically significantly in the music group (P < 0.0001), but not in the group listening to audiobooks. CONCLUSION: Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy to learn method to treat insomnia.