There is emerging evidence, although at early stages, of various detrimental health effects after smoking shisha. With regard to the cardiovascular system, there is a signifi cant acute rise in cardiovascular markers, such as heart rate and blood pressure. The long-term effects on the cardiovascular system are yet to be established. Shisha smoking has also been signifi cantly associated with lung cancer. Various other forms of cancer have also been documented, but have not reached statistical signifi cance and require further research. Finally, shisha smoking increases the risk of infection and has been associated with outbreaks in the Middle East. Therefore, with the increasing consumption of shisha in Europe, especially in the UK, more research is required to tackle this potential public health threat.

Objectives To investigate the readability and presence of translated online information readily available to the British public during COVID-19. Design A cross-sectional study was performed. The terms "Coronavirus", "COVID-19", "Lockdown", "Social Distancing", "Handwashing", "Furlough Scheme" and "Sick pay" were inputted into the popular search engine, Google. Websites were categorised by their source (i.e. Government, Non-Governmental Organisation, NHS and Commercial) and theme (i.e. general COVID-19 information, population practise and employment rulings). Reliable calculators for assessing readability (Simple Measure of Gobbledygook, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index and Automated Readability Index) were used. Main Outcome Measures The median scores with the interquartile range from each calculator of the pooled data were observed. The presence of accompanying translated material and graphic information was also counted and presented as counts and percentages. The number of readable websites (i.e. a score ≤ 8) for each source and theme category were also recorded. Setting UK Internet servers. Results The median scores of the pooled data (n = 148) had shown that the majority of websites were unreadable to the average British reader according to each calculator used (SMOG 1.3%; GF 6.8%; FK 35.8%; CL 2.6%; ARI 40%). Only 3.4% and 6.8% of the pooled websites had readily available translated material and accompanying graphic material, respectively. Conclusion Readability of COVID-19 information is below national standards and that there is a lack of accompanying translated and graphics-based material online. This may lead to an amplified level of misunderstanding in BAME populations about the COVID-19 pandemic and the rulings put in place.

ObjectivesTo investigate the acute cardiovascular effects of smoking shisha.DesignA cross-sectional study was carried out in six shisha cafes. Participants smoked shisha for a period between 45 min (minimum) and 90 min (maximum). The same brand of tobacco and coal was used.SettingLondon, UK.ParticipantsParticipants were those who had ordered a shisha to smoke and consented to have their blood pressure, heart rate and carbon monoxide levels measured. Excluded subjects were those who had smoked shisha in the previous 24 h, who smoke cigarettes or who suffered from cardiorespiratory problems.Main outcome measuresBlood pressure was measured using a sphygmomanometer. Pulse was measured by palpation of the radial artery. Carbon monoxide levels were obtained via a carbon monoxide monitor. These indices were measured before the participants began to smoke shisha and after they finished or when the maximum 90 min time period was reached.ResultsMean arterial blood pressure increased from 96 mmHg to 108 mmHg (p < 0.001). Heart rate increased from 77 to 91 bpm (p < 0.001). Carbon monoxide increased from an average of 3 to 35 ppm (p < 0.001). A correlation analysis showed no relationship between carbon monoxide and the other indices measured.ConclusionThe acute heart rate, blood pressure and carbon monoxide levels were seen to rise significantly after smoking shisha. The weak correlation between carbon monoxide levels and the other variables suggests that carbon monoxide levels had not contributed to their significant increase.

Increased BMI at booking was associated with a reduced incidence of minor perineal trauma at delivery, but was not associated with OASIS.