Moving Towards Greater Justice: A Community-Based Research Project on Transit Affordability in Toronto

This report reflects on a collaborative advocacy research project I undertook in partnership with the Fair Fare Coalition (FFC), a transit activist and advocacy organization in Toronto. The project is a community-based research project on transit affordability involving the participation of low-income Torontonians throughout the city. The purpose was to bring together voices that are usually excluded from official city planning discourses and decision-making processes to highlight some of the frequently unaccounted for "costs" of increasing transit fares in Toronto – for example, on individual and community health and well-being. Through this, the Fair Fare Coalition hoped to build capacity and mobilize knowledge towards advocating for policy measures to increase transit affordability in Toronto. The participatory project's goals and outcomes are twofold. One goal is for the participatory process to culminate in a project deliverable that could be used for advocacy purposes in support of the Fair Fare Coalition's advocacy goals. The second goal is increasing community knowledge-building and mobilization, including ongoing political and advocacy actions. This is to highlight the fact that both the process and outcome are valuable and important. For the purposes of this report, I will contextualize and situate the significance of the FFC project in Toronto, providing background, exploring relevant literature, and explaining the importance of the research methodology. I will then share brief findings from the research, and provide analysis of both the outcomes and process of the research project

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

Background: Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged >= 70 years with type 2 diabetes mellitus. Methods: The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. Results: After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. Conclusions: We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus