Objective To determine whether full elbow extension as assessed by the elbow extension test can be used in routine clinical practice to rule out bony injury in patients presenting with elbow injury. Design Adults: multicentre prospective interventional validation study in secondary care. Children: multicentre prospective observational study in secondary care. Setting Five emergency departments in southwest England. Participants 2127 adults and children presenting to the emergency department with acute elbow injury. Intervention Elbow extension test during routine care by clinical staff to determine the need for radiography in adults and to guide follow-up in children. Main outcome measures Presence of elbow fracture on radiograph, or recovery with no indication for further review at 7-10 days. Results Of 1740 eligible participants, 602 patients were able to fully extend their elbow; 17 of these patients had a fracture. Two adult patients with olecranon fractures needed a change in treatment. In the 1138 patients without full elbow extension, 521 fractures were identified. Overall, the test had sensitivity and specificity (95% confidence interval) for detecting elbow fracture of 96.8% (95.0 to 98.2) and 48.5% (45.6 to 51.4). Full elbow extension had a negative predictive value for fracture of 98.4% (96.3 to 99.5) in adults and 95.8% (92.6 to 97.8) in children. Negative likelihood ratios were 0.03 (0.01 to 0.08) in adults and 0.11 (0.06 to 0.19) in children. Conclusion The elbow extension test can be used in routine practice to inform clinical decision making. Patients who cannot fully extend their elbow after injury should be referred for radiography, as they have a nearly 50% chance of fracture. For those able to fully extend their elbow, radiography can be deferred if the practitioner is confident that an olecranon fracture is not present. Patients who do not undergo radiography should return if symptoms have not resolved within 7-10 days.

Objectives: In past studies, a lack of social support has been associated with cardiovascular disease (CVD) risk, particularly in black Africans. However, whether or not coping strategies have beneficial effects on blood pressure (BP) and emotional well-being is not clear. We therefore assessed the relationship between BP levels, depression and coping strategies. Methods: A prospective bi-ethnic cohort followed 359 black and white South African school teachers (aged 20-65 years) over a three-year period. Data on ambulatory 24-hour blood pressure, depression, coping strategies (defensiveness, social support, avoidance) and culture-specific coping scores (cognitive/emotional debriefing, spiritual-, collectivistic and ritualcentred) were obtained. Results: Over three years, chronic depression (38 vs 19%) and hypertension (68 vs 35%) were apparent in blacks (d-values > 0.3) as opposed to whites. In both groups, depression was accompanied by more avoidance (loss-of-control) coping. Consistent spiritual and increasing collectivistic coping were apparent in whites. Over time, increasing defensiveness (OR 1.08, p ≤ 0.05) and ritual coping (OR 1.27, p ≤ 0.01; d-values > 0.5), predicted chronic depression in blacks. The change in their symptoms of depression predicted 24-hour hypertension (OR 1.11, p = 0.04). No similar associations existed in whites. Conclusions: Blacks showed increasing defensiveness and ritual-and spiritual-centred coping in an attempt to combat chronic depression, which may be costly, as reflected by their chronic hypertensive status. Whites showed consistent spiritual-centred coping while utilising avoidance or loss-of-control coping, with a trend of seeking less social support or isolation as a coping mechanism. During counselling of depressed patients with hypertension, the beneficial effects of social support and spiritual coping may be of great importance.

This article is dedicated to Professor Gert Breed who had an indelible influence in the expansion of Pastoral Theology in South Africa: first as minister, and second as Professor in Practical Theology. In line with Professor Breed’s keen interest in the interdisciplinary approach between Theology and, for instance, Physiology and Psychology, the main aim of this article is to show how utilising spiritual coping strategies could help the Christian to cope with stress from a faith perspective. Spiritual coping was defined as an individual’s ability to utilise faith in God and Judeo-Christian religious beliefs, as well as active practices to appraise, understand and effectively cope with stressful life events. A literature study was conducted on human defence response and spiritual coping to demonstrate the adverse effects of chronic defensiveness and stress. Spiritual coping was assessed from a scriptural approach to determine what biblical perspectives regarding coping, defensiveness and spirituality may be revealed. Effective coping strategies were explored to indicate how positive spiritual coping skills could be utilised as an alternative to chronic defensives. The Believe-Belong-Behave pastoral model was proposed for the utilisation of spiritual coping methods and skills that could improve psychophysiological well-being. The Believe-Belong-Behave model consists of three categories that each highlight different individual skills, corporate practices, and practical action steps, which, when applied consistently, could all function in harmony to promote psychophysiological well-being. The components of the proposed pastoral model could offer a harmonious contribution towards spiritual coping and the Christian’s spiritual formation within the local church.Contribution: This article assessed theological perspectives and biblical practices within the basic tenets of Reformed theology to identify resemblances to stress appraisal and human defensiveness throughout the historical course of Scripture. This study in Practical Theology highlighted the importance of combining a strong scriptural or theological foundation with certain practical skills to respond to stressors from a faith-in-action perspective. The proposed pastoral model showed the modern-day Christian how faith in God could be used to cope with stress more effectively.

Spiritual coping has been defined as an individual’s ability to utilise faith in God combined with certain Christian beliefs and religious practices to appraise, understand, and effectively cope with stress. We aimed to show the Christian how specific spiritual coping strategies and religious practices could be used to effectively assess and handle chronic stress from a faith perspective amid the ongoing coronavirus disease 2019 (COVID-19) pandemic and beyond. A literature study was conducted to identify positive and negative coping strategies during the COVID-19 era and highlighted the adverse effects of chronic stress and defensiveness. Recent findings on religion, the validated bio-engineered chronic stress phenotype, the Coping Strategy Indicator (CSI), Africultural Coping Systems Inventory (ACSI) and the effect of spiritual coping skills were assessed. In addition, certain Bible passages and theological perspectives regarding spiritual coping were explored to identify traces of the fight-or-flight response in the Garden of Gethsemane. The novel chronic stress phenotype reflecting stroke risk, could determine the prevalence of chronic stress. Positive coping strategies were identified, to show how positive spiritual coping skills could be utilised from a faith perspective, in coping with chronic stress amid COVID-19 and beyond. The Believe-Belong-Behave pastoral model, consisting of individual skills, corporate practices, and practical action steps, showed the Christian how certain spiritual coping skills and practices could be implemented during stress coping. The scriptural insights gained from this study, combined with the pastoral model reviewed, could offer a harmonious contribution toward the Christian’s ability to utilise spiritual coping strategies amid COVID-19 chronic stress-induced symptoms and complexities.Contribution: This article used an inter-disciplinary approach to compare recent findings within Theology, Neurophysiology, Bio-engineering, and Psychology regarding religion, stress-phenotyping, positive stress-coping and mental health. The scriptural foundation encouraged a faith-in-action response to chronic stress during the ongoing COVID-19 pandemic and beyond.