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This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_07_18_CJASNPodcast_18_8_F.mp3.

An understanding of the influence of sex (biological attributes) and gender (socially constructed roles, behaviours, expressions, identities) factors on the risk of infection, hospitalization and death is of urgent importance in the COVID-19 pandemic response effort. Despite similar global rates of infection with Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2, the virus responsible for the COVID-19 pandemic), hospitalizations and mortality are higher in men than in women. Females may be less vulnerable to viral infection due to sex-based differences in immune responses and renin-angiotensin system activity. The response and side effects of currently studied potential therapies for COVID-19, such as hydroxychloroquine, likely differ by sex. Women form the majority of the health care workforce and a uniform approach to sizing of personal protective equipment may provide differing levels of protection from viral infection to health care workers of varying shapes and sizes. Important gender differences exist in the response to public health measures to prevent and contain spread of COVID-19, as well as presentation for testing and medical care, which may inadvertently propagate viral spread. Targeted approaches that consider both sex and gender, as well as measures of intersectionality, are urgently needed in the response efforts against COVID-19. Résumé Il est d'une importance primordiale, pour riposter à la pandémie de COVID-19, de comprendre l'influence des facteurs liés au sexe (les attributs biologiques) et au genre (les rôles, comportements, expressions et identités socialement construits) sur les risques d'infection, d'hospitalisation et de décès. Malgré la similarité mondiale des taux d'infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-Cov-2, le virus responsable de la pandémie de COVID-19), les hospitalisations et la mortalité sont plus élevées chez les hommes que chez les femmes. Celles-ci pourraient être moins vulnérables à l'infection virale en raison de différences sexuelles dans les réponses immunitaires et dans l'activité du système rénine-angiotensine. Les réactions et les effets secondaires aux traitements possibles de la COVID-19 actuellement à l'étude, comme l'hydroxychloroquine, diffèrent probablement selon le sexe. Comme les femmes composent la majorité de la main-d'oeuvre des soins de santé, les tailles uniformes de l'équipement de protection individuelle offrent peut-être des niveaux de protection inégaux contre l'infection virale aux travailleurs de la santé de formes et de tailles différentes. Il existe des différences importantes entre les genres dans les réactions aux mesures de santé publique visant à prévenir et à contenir la propagation de la COVID-19 et dans la présentation aux tests et aux soins médicaux, ce qui pourrait par inadvertance favoriser la propagation virale. Dans la riposte à la COVID-19, il devient urgent d'adopter des approches ciblées, qui tiennent compte à la fois du sexe et du genre, ainsi que des mesures de l'intersectionnalité.

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A rural and remote international clinical exchange permits the senior nursing student to experience another culture and to develop a feel for daily life and nursing practice abroad. In a student exchange between Australia and Canada, similarities exist with regard to life and work for nurses who live in these developed countries. Similarities extend to a growing population base of original inhabitants or indigenous peoples with complex health challenges. Differences, however, are also apparent in rural and remote health care delivery due to the uniqueness of each country's demographics, nursing programs, nursing culture, and health care systems. In the rural hospitals of the Riverland region, South Australia, the Australian public and private health care systems are witnessed working side by side. Aboriginal health care with its unique cultural care practices was experienced in the remote Aboriginal community of Hermannsburg in the Northern Territory, and in the district hospital in Alice Springs. The international exchange provided the opportunity to reflect on the impact of the social determinants of health, and the similarities and differences between developed countries in nursing practice and nursing culture. The sense of community and autonomy gained in rural and remote placements in Australia provided incentive for nursing students to consider this area of practice on their return to Canada.

Background: Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females. Methods: We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013–2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity. Results: Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%–46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02–2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44–3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63–2.45), asthma (adjusted OR 1.82, 95% CI 1.52–2.19), arthritis (adjusted OR 1.98, 95% CI 1.74–2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48–2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02–1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12–1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis. Interpretation: We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.

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