Tutorial 5 – Questions

Confidence interval for a mean and comparison of two means

1. Plasma magnesium. Plasma magnesium was measured in a sample of 227 diabetic subjects. The
diabetic subjects were all insulin-dependent and attending a diabetic clinic over a 5 month
period. The sample mean and sample standard deviation were 0.719 mmol/L and 0.068 mmol/L.
The plasma magnesium levels were normally distributed.

a. Calculate an interval which would include 95% of plasma magnesium measurements.

This is what we call the 95% reference range.
b. Calculate the standard error of the sample mean and the 95% confidence interval of the
population mean magnesium levels of diabetic subjects.
c. How does the 95% confidence interval differ from the 95% reference range? Why are
they different?

2. BreastScreen Victoria. One of the adverse effects of long term use of hormone replacement
therapy (HRT) is a modest increase in the risk of breast cancer. In order to evaluate the
association between HRT use and tumour size a random sample of women diagnosed with
invasive breast cancer was selected from the mammographic screening program of
BreastScreen Victoria. The sample consisted of 201 women who were current users of HRT with
mean tumour size 14.76 mm, standard error of the mean 0.61 mm (95% Confidence interval (CI)
13.56 to 15.96) and 247 women who were not on HRT with mean tumour size 14.08 mm,
standard error of the mean 0.61 mm (95% CI 12.88 to 15.28).

a. Calculate the standard error of the difference between the mean tumour size in each of
the groups (i.e. women diagnosed with invasive breast cancer who have, and have not,
used HRT), and then use this standard error to produce a 95% confidence interval for
the population mean difference in tumour size between the two groups.
b. What is your interpretation of the estimated mean difference and the associated
confidence interval?
3. Exercise and nutrition. This question is based on the study described in Canuto et al. (2012)
‘Pragmatic randomised trial of a 12-week exercise and nutrition program for Aboriginal and
Torres Strait Islander women: clinical results immediate post and 3 months follow-up’. BMC
Public Health, 12:933.

The primary aim of the Canuto et al. (2012) study was to evaluate the effectiveness of a 12-week
structured exercise and nutrition program in a cohort of urban Indigenous Australian women on
a number of outcomes including body mass index (BMI; kg/m2). The program included two 60
minute group cardiovascular and resistance training classes per week, and four nutrition
education workshops. BMI was measured in 100 Aboriginal and/or Torres Strait Islander women
aged 18–64, of whom 51 were randomly assigned to an ‘active’ group (that did participate in the
training classes) and 49 to a ‘waitlisted’ control group (that participated in the training classes
12 months later). BMI was measured at baseline and immediately after the 12 week fitness
program. The sample mean and sample standard deviation (sd) of the BMI measurements
recorded at these time points are summarised in the table below.

Baseline Post fitness program

Mean BMI (sd), kg/m2 Mean BMI (sd), kg/m2
Active (N=51) 36.1 (7.7) 32.2 (6.7)
Waitlisted (N=49) 33.5 (7.5) 35.1 (6.5)

a. Calculate the difference in mean BMI between those women in the active group and
waitlist group at baseline, and the corresponding 95% confidence intervals for the
population mean differences.

b. Post fitness program, the 95% confidence interval for the population mean difference
in BMI between women in the active and waitlisted groups was (-5.49, -0.31).
Comment on how we could use this information to argue at a population level that
women in the fitness program have reduced BMI compared to the waitlisted group.

4. State which of the following are TRUE or FALSE. The 95% confidence limits for the population
mean estimated from a set of observations are:-

a. limits between which, in the long run, 95% of observations fall

b. a way of measuring the precision of the estimate of the population mean
c. limits within which the sample mean falls with probability 0.95
d. limits which would include the population mean for 95% of possible samples
e. a way of measuring the variability of a set of observations