Skin & Allergy News articles from March 2008

Skin & Allergy News archives from March 2008

Ustekinumab's next psoriasis stop: FDA.(News)
March 1, 2008... [ILLUSTRATION OMITTED] SAN ANTONIO -- Long-term, continuous use of ustekinumab for maintenance therapy in patients with moderate to severe plaque psoriasis is efficacious and generally well tolerated, according to phase III study findings...

Melanoma quality measures dropped from Medicare P4P: emphasis is placed on EMRs, e-prescribing.(News)
March 1, 2008... Three melanoma measures that were added to the Physician Quality Reporting Initiative in mid-2007 have been eliminated, leaving dermatologists with limited opportunities to qualify for bonus payments from the Center for Medicare and Medicaid...

Controversy lingers over sunscreen seal program.(News)
March 1, 2008... SAN ANTONIO -- The American Academy of Dermatology's Seal of Recognition program continued to raise concerns among some dermatologists at the Academy's annual meeting. Since the program was approved in July 2006, two products have been...

Mayo patch test changes highlighted.(News)
March 1, 2008... A 5-year review of allergen patch testing by the Mayo Clinic revealed a number of important differences from the standard series at other institutions, and also from an earlier period at the Mayo Clinic. In their review of 3,854 patients...

Who should pay for Americans' Health Insurance.(VITAL SIGNS)
March 1, 2008... Who Should Pay for Americans' Health Insurance? Mostly individuals 6% Mostly employers 8% Mostly government 15% Individuals, employers, 66% and government should share costs Notes: Based on a...

Vascular placental flaw, hemangioma link studied.(News)
March 1, 2008... Vascular abnormalities of the placenta were strongly correlated with he incidence of infantile hemangiomas in a small group of very-low-birth-weight infants, Dr. Juan Carlos Lopez Gutierrez and his colleagues reported. Abnormalities such...

Humira.(New & Approved)
March 1, 2008... Humira (adalimumab, Abbott) A tumor necrosis factor (TNF)-blocker has been approved by the Food and Drug Administration for treating adults with moderate to severe chronic plaque psoriasis "who are candidates for systemic therapy or...

Risk-benefit favorable for new oral psoriasis Tx.(News)
March 1, 2008... SAN ANTONIO -- A novel oral therapy with broad anti-inflammatory activity is showing promise for the treatment of moderate to severe plaque psoriasis, according to phase II study data presented at the annum meeting of the American Academy of...

Dermatology grants are awarded.(News)(Brief article)
March 1, 2008... Dermatology research grants have been awarded by the National Rosacea Society and the Skin Cancer Foundation. Four research teams have received $25,000 each from the National Rosacea Society. Dr. Richard Gallo of the University of...

Fraud scheme among insurers investigated in N.Y.(News)
March 1, 2008... Following a 6-month initial investigation, New York Attorney General Andrew Cuomo announced plans to file suit against UnitedHealth Group and four of its subsidiaries for allegedly systematically underpaying consumers for their out-of-network...

New botulinum toxin injection warnings issued: postinjection symptoms include dysphagia, ptosis, and shortness of breath, according to the FDA.(News)
March 1, 2008... The Food and Drug Administration issued a warning last month advising patients and physicians that botulinum toxins have in some cases been linked to respiratory failure and even death. Physicians should be vigilant for postinjection...

Botox under investigation as possible treatment for Raynaud's.(News)
March 1, 2008... BEVERLY HILLS, CALIF. -- Sympathectomy may become rare as a treatment for Raynaud's phenomenon, even in severe cases, if early success with botulinum toxin type A injections proves lasting and replicable, Dr. Michael Neumeister said at the...

Possibility of melanoma in children often ignored.(News)
March 1, 2008... ORLANDO -- Cancer already kills more children aged 1-14 years than does any other disease, and the incidence of childhood melanoma is on the rise, Dr. Jane M. Grant-Kels said at the annual meeting of the Florida Society of Dermatologic...

Psychiatric Dx seen with urticaria.(News)
March 1, 2008... Nearly half of all patients with chronic idiopathic urticaria have Axis I psychiatric diagnoses and 45% have Axis II diagnoses, according to a new study. Obsessive-compulsive disorder (OCD) and major depression were the most common Axis I...

Verbatim.(News)
March 1, 2008... 'We were wrong on vitamin A. We were wrong on vitamin B. We were wrong on vitamin C. We were wrong on vitamin E. Except for K, there's only one letter left--and that's D.' Dr. Robert A. Vogel, on longevity benefits linked to vitamin D, p....

Future laser may hit fat target.(Guest Editorial)
March 1, 2008... Could fat be treated with a laser or some other kind of noninvasive delivery of energy from the skin surface? To reduce fat without damaging the epidermis and dermis, we face some difficult challenges. One of which is having to go several...

If it's wet, dry it.(Under My Skin)
March 1, 2008... Nondermatologists like to mock, "Hey, we know what you guys do: If it's wet, dry it, and if it's dry, wet it." Most of the students who follow me around are headed for primary care. When I meet a new one, I'm tempted to say, "The goal of...

'Behind-the-counter' prescribing is problematic.(Guest Editorial)
March 1, 2008... Americans are desperate for ways to reduce the costs of health care and improve access to care. At the same time, physicians are frustrated with the status quo. After a 30-year campaign by the media to disparage physicians with negative stories...

Feds need to help bring vaccines to U.S. market.(Guest Editorial)
March 1, 2008... Vaccine shortages have become all too common in the United States, with no end in sight. The best solution would be for the federal government to step in and provide incentives to vaccine manufacturers to bring more products to the U.S. market....

Clinton article had negative spin.(Letters)(Letter to the editor)
March 1, 2008... I was disappointed to note the decidedly negative spin you placed upon Sen. Hillary Rodham Clinton's health plan by headlining the article with the relatively inconsequential portion dealing with nonphysician roles ("Sen. Clinton Urges Wider...

To Clinton: leave physicians alone.(Letters)(Letter to the editor)
March 1, 2008... Have we forgotten that Sen. Hillary Rodham Clinton's 1993 "Hillary Care" was written without the consultation of one physician ("Sen. Clinton Urges Wider Role for Nonphysicians," December, 2007, p. 49)? There were 550 "consultants," and...

Empathy needed in our profession.(Letters)(Letter to the editor)
March 1, 2008... I want to thank Dr. Alan Rockoff for his touching and salient column, "Skating Along the Surface" (Under My Skin, December 2007, p. 13). As a dermatologist and clinical psychologist, I continually struggle with the obvious angst and...

Correction.(Letters)(Correction notice)
March 1, 2008... In a supplement to SKIN & ALLERGY NEWS ("Examining Alternative Topical Therapy for Atopic Dermatitis," January 2007, p. 3), the topical corticosteroid desonide should have been described as being available in a proprietary hydrogel formulation....

Interferon is an "imperfect standard" for melanoma.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- For patients with regionally advanced melanoma, the current standard of care is high-dose interferon. "It's an imperfect standard, but nonetheless it is the standard," Dr. Michael P. Kosty said at a melanoma update sponsored...

Grading dysplastic nevi: easy as present or not.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- There's no need to grade the level of architectural disorder when assessing dysplastic nevi. Just acknowledge if it's present or not. "It doesn't matter how much architectural disorder is there; it only matters that it's...

Topical 5% imiquimod effectively treats Bowen's disease.(Cutaneous Oncology)
March 1, 2008... ORLANDO -- Topical 5% imiquimod is an effective treatment for squamous cell carcinoma in situ and should be considered as an option for this disease, Dr. Theodore Rosen reported at the annual meeting of the Florida Society of Dermatologic...

Mohs surgery best for ears, nose, and digits.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- What is an adequate margin for surgical excision of melanoma? Beyond a clear margin, "we really don't know," Dr. Duane C. Whitaker said at a melanoma update sponsored by the Scripps Clinic. That's why there's a place for...

Incisional biopsy best when uncertain, expert says.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- If you're confident that a primary lesion is melanoma, do an excisional biopsy and send the entire specimen to a pathologist. If you're less certain about the diagnosis, you can do an incisional biopsy of the primary lesion...

Radiation brochure free to download.(Cutaneous Oncology)
March 1, 2008... The brochure "Radiation Therapy for Skin Cancer" includes the up-to-date information for skin cancer patients who are deciding whether radiation therapy is the best option for them. It contains information about the different treatments...

Melanoma follow-up rests on history physical exam.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- When it comes to follow-up surveillance of melanoma patients, history and physical examination remain the cornerstone of good care, with little solid evidence to support anything else. "The literature on this aspect of melanoma...

Patients may need convincing about sunscreen's importance.(Cutaneous Oncology)
March 1, 2008... SAN DIEGO -- When Dr. Michael Swarm advises patients to apply sunscreen to protect against melanoma, the suggestion sometimes falls on deaf ears. "Patients who don't want to wear sunscreen will say, 'I don't wear sunscreen because it's...

Skin care is important element of rejuvenation.(Aesthetic Dermatology)
March 1, 2008... In treating cosmetic dermatology patients for symptoms associated with aging, procedures are not enough, Dr. Leslie Baumann said in a Galderma-sponsored symposium held during the 21st World Congress of Dermatology in Buenos Aires. "Skin...

FDA updates info on injectable fillers.(Aesthetic Dermatology)(Brief article)
March 1, 2008... The Food and Drug Administration has updated the information that is available on its Web site for consumers and health professionals on injectable fillers. In late January, the agency posted data on materials used; indications; risks;...

New ablative fractional laser system makes debut.(Aesthetic Dermatology)
March 1, 2008... A laser system for skin rejuvenation hat delivers ablative fractional resurfacing technology made its official debut at the annual meeting of the American Academy of Dermatology. [ILLUSTRATION OMITTED] Manufactured by Mountain View,...

Porcine collagen could be answer to filler longevity.(Aesthetic Dermatology)
March 1, 2008... LAS VEGAS -- Porcine collagen crosslinked with D-ribose probably lasts as long or longer than does hyaluronic acid when used as a cosmetic filler for lips and nasolabial folds, Dr. Gary Monheit said at the annual meeting of the American Society...

Deep heating skin found to improve fractional resurfacing.(Aesthetic Dermatology)
March 1, 2008... CHICAGO -- The clinical results of fractional skin resurfacing may be improved by pretreatment with an infrared laser or broadband infrared light source, according to a pilot study presented at the annual meeting of the American Society for...

Injection lipolysis is both defended, criticized: 'we've been using injection lipolysis in my clinic for 2 years now and getting excellent results.'.(Aesthetic Dermatology)
March 1, 2008... Recent months have had a raft of bad news about injection lipolysis. Two prominent medical spas whose business was providing the popular treatments abruptly closed their doors, leaving patients in the lurch. Then, the Kansas Board of Healing...

Apigenin.(Cosmeceutical Critique)
March 1, 2008... Apigenin (5,7,4'-trihydroxyflavone) is a low-toxic, nonmutagenic plant avonoid that is widely found in herbs (endive, clove, and German chamomile), fruit (apples, cherries, and grapes), beverages (tea and wine), vegetables (beans, broccoli,...

Expert favors proven agents over peptide cosmeceuticals.(Aesthetic Dermatology)
March 1, 2008... LAS VEGAS -- Dermatologists should tell their patients to be skeptical of "peptide" cosmeceuticals and to stick with proven agents, Dr. Kathy A. Fields said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic...

Antibiotic prophylaxis discouraged before surgery.(Dermatologic Surgery)
March 1, 2008... ORLANDO -- Most dermatologic surgery patients don't need perioperative antibiotics, and the routine use of antibiotics to prevent surgical site infection or infective endocarditis should be discouraged, Dr. Steve Spencer said at the annual...

C[O.sub.2] ablation/curettage proves successful in Darier's patient.(Dermatologic Surgery)
March 1, 2008... ORLANDO -- C[O.sub.2] laser ablation with aggressive curettage proved successful for the treatment of a patient with Darier's disease who had failed other medical therapies. The C[O.sub.2] laser/curettage approach was initially used on one...

Preventive practices can blunt suture needle sticks.(Dermatologic Surgery)
March 1, 2008... CHICAGO -- Most of the estimated 1,000 suture needle sticks endured by surgeons and surgical residents in the United States each day can be prevented by protecting the needle point within the needle driver, according to Dr. Joy Kunishige. ...

Hybrid technique offers yet another Tx for varicose veins.(Dermatologic Surgery)
March 1, 2008... CHICAGO -- A technique that combines occlusion coils and alcohol sclerosis is the latest addition to the array of catheter-based approaches available to treat varicose veins. "We have yet another tool in an area where I don't think we...

'Thinking errors' provide chance for reflection.(Pediatric Dermatology)
March 1, 2008... MONTEREY, CALIF. -- Harvard Medical School hematologist Dr. Jerome Groopman has said that "people talk about technical errors in medicine, but no one talks about thinking errors." This sentiment registered with Dr. Bari B. Cunningham, a...

Iatrogenic events reported in 30% of hospitalized neonates.(Pediatric Dermatology)
March 1, 2008... Iatrogenic events occur quite frequently in the care of high-risk neonates, according to a study from France that found 116 of 388 patients admitted to a neonatal unit experienced an event. Twenty-nine percent of the 267 events were...

Restricting diet for prevention of atopy has limited worth.(Pediatric Dermatology)
March 1, 2008... The documented benefits of nutritional intervention that might prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy because a parent or sibling has allergic disease, according to a...

Parental worry may add to vulvovaginal disease.(Pediatric Dermatology)
March 1, 2008... SAN FRANCISCO -- Spend plenty of time addressing parents' concerns about a child's vulvovaginal disease or their worries may contribute to the problem, Dr. Libby Edwards said at a meeting sponsored by Skin Disease Education Foundation. ...

Diarrhea may resolve, but C. difficile spores remain.(Infectious Diseases)
March 1, 2008... Patients with Clostridium difficile-associated disease frequently are contaminated on multiple skin sites that may remain a source of transmission even after the diarrhea has resolved. [ILLUSTRATIONS OMITTED] In this study of 27...

Many adults blase about receiving routine immunizations.(Infectious Diseases)
March 1, 2008... WASHINGTON -- Approximately half of 1,005 American adults surveyed by the National Foundation for Infectious Diseases said that they were unconcerned that either they or a family member will become infected with a vaccine-preventable disease,...

FDA grants new cephalosporin fast-track status.(Infectious Diseases)
March 1, 2008... Monotherapy with ceftobiprole was found to be as effective as vancomycin plus ceftazidime for treating patients with a broad range of complicated skin and skin-structure infections caused by gram-positive and gram-negative bacteria. ...

Gonorrhea treatment 'hanging by a thread'.(Infectious Diseases)
March 1, 2008... SAN DIEGO -- Resistance to gonorrhea drugs is climbing just as treatment options are dwindling, making for a potential public health crisis if more drug choices are not brought to market soon. "The situation is really not good. We're...

Norovirus was spread via school computers.(Infectious Diseases)
March 1, 2008... An outbreak of norovirus in a District of Columbia elementary school last year was probably transmitted by unclean computer mice and keyboards. The Centers for Disease Control and Prevention was notified after 27 students and two staff...

Adalimumab shows long-term safety, efficacy.(Psoriasis)
March 1, 2008... SAN ANTONIO -- Adalimumab proved safe and effective when used for up to 2 years for the treatment of psoriatic arthritis in a phase III open-label extension study, according to results reported at the annual meeting of the American Academy of...

Methotrexate side effect profiles differ among PsA, RA patients.(Psoriasis)
March 1, 2008... Methotrexate had a different adverse event profile in psoriatic arthritis and rheumatoid arthritis patients in a study of more than 1,000 "everyday" patients treated in 30 rheumatology clinics across 13 countries. "We have suspected for...

After initial alefacept response, long-term remission reported.(Psoriasis)
March 1, 2008... SAN ANTONIO -- Multiple courses of alefacept effectively sustain the long-term remission of chronic plaque psoriasis in patients who respond to a first course of the drug, according to a recent study. In a multinational, open-label...

Drug promising for vaginal dryness after breast cancer.(Across Specialties)(Clinical report)
March 1, 2008... SAN ANTONIO -- Pilocarpine has potential as a nonestrogenic treatment for the vaginal dryness that is a common and problematic complaint in breast cancer survivors, Dr. Charles L. Loprinzi said at the annual San Antonio Breast Cancer Symposium....

Vulvar and vaginal symptoms are common in pregnancy.(Across Specialties)(Medical condition overview)
March 1, 2008... CHICAGO -- Many women report vulvar and vaginal symptoms during pregnancy, but little is known about the frequency, severity, and timing of such complaints as vulvar pain, burning, itching, and dyspareunia, said Dr. Colleen M. Kennedy of the...

Comprehensive treatment essential for vulvodynia.(Across Specialties)
March 1, 2008... SAN FRANCISCO -- Vulvodynia so profoundly affects quality of life that management needs to address the physical, psychological, sexual, and relationship problems that are caused by the pain. "Support, support, support" patients who have...

Combination of symptoms point to endometriosis Dx.(Across Specialties)
March 1, 2008... WASHINGTON -- The constellation of symptoms characterizing endometriosis may be more specific than currently thought, Karen D. Ballard, Ph.D., said at the annual meeting of the AAGL. There is often a long delay in the diagnosis of...

BRCA1 carriers need 'more frequent imaging'.(Across Specialties)(Clinical report)
March 1, 2008... SAN ANTONIO -- Annual breast cancer screening by mammography plus MRI is insufficient for BRCA1 mutation carriers, according to the midterm results of the Dutch MRI Screening Study. "It's clear the interval cancer rate is much higher in...

Oral contraceptives may prevent ovarian cancer.(Across Specialties)
March 1, 2008... The use of oral contraceptives confers long-term protection against ovarian cancer, and the longer birth control pills are used, the greater their protective effect, according to an analysis of 45 epidemiologic studies from around the world....

Breast cancer leads mortality drop in United States, Britain.(Across Specialties)
March 1, 2008... SAN ANTONIO -- Total cancer mortality among middle-aged women in the United States and United Kingdom has declined markedly since 1990--and an unprecedented drop in breast cancer mortality is the biggest reason why, Sir Richard Peto, Ph.D.,...

Compliance a challenge for older epilepsy patients: comorbidities, likelihood of living alone or having dementia fuel nonadherence.(Across Specialties)(Clinical report)
March 1, 2008... PHILADELPHIA -- Compliance with antiepileptic drugs was worse in the elderly than in younger patients, and noncompliant patients were more likely to have serious sequelae including death, based on results from two separate studies. ...

Epilepsy diagnosis after one seizure remains controversial.(Across Specialties)
March 1, 2008... PHILADELPHIA -- A new, operational definition of epilepsy may go a long way toward resolving the question of whether epilepsy can be diagnosed and treatment begun after a single seizure or whether two seizures are required. Under the new...

Drug withdrawal safe after seizure-free period.(Across Specialties)
March 1, 2008... PHILADELPHIA -- Most epilepsy patients whose seizures are completely controlled by antiepileptic drugs can eventually attempt withdrawal from treatment with a low risk of complications, Dr. Peter Camfield said at the annual meeting of the...

Manage vasculitis relapse with individual approach.(Across Specialties)
March 1, 2008... BOSTON -- Although 3 decades have passed since the introduction of a regimen combining daily oral cyclophosphamide with prednisone transformed antineutrophil cytoplasmic antibody-associated vasculitis from a uniformly fatal disease to one with...

Familial risk round to be low for ANCA-associated vasculitis.(Across Specialties)
March 1, 2008... BOSTON -- The occurrence of ANCA-associated vasculitis among close relatives of individuals with the condition is low, a Swedish study has shown. The findings provide insight into the long-unanswered question of genetic susceptibility of...

Low vitamin D may set stage for heart disease.(Across Specialties)(Clinical report)
March 1, 2008... Vitamin D deficiency may crease the risk of cardiovascular disease in adults, especially in people who also have hypertension, based on data from the Framingham Offspring Study. More studies are needed to show whether correcting vitamin D...

Growing evidence supports vitamin D's longevity benefit.(Across Specialties)
March 1, 2008... SNOWMASS, COLO. -- Mounting evidence strongly suggests routine vitamin D supplements reduce all-cause mortality. "We may finally have a vitamin that translates into greater longevity," declared Dr. Robert A. Vogel, professor of medicine at...

Costs may determine use of pipeline biologic agents.(Across Specialties)
March 1, 2008... SNOWMASS, COLO. -- The many biologic agents for rheumatoid arthritis now in mid- to late-stage development are likely to have little impact on clinical practice unless they are priced substantially lower than those now available, Dr. Mark C....

Oral small-molecule drugs may be future RA treatment.(Across Specialties)
March 1, 2008... SNOWMASS, COLO. -- The next major advance in rheumatoid arthritis therapy will be oral small-molecule drugs targeting novel intracellular enzyme pathways, Dr. Mark C. Genovese predicted at a symposium sponsored by the American College of...

Folic acid supplementation may reduce methotrexate efficacy.(Across Specialties)
March 1, 2008... BOSTON -- Folic acid supplementation can decrease the risk of adverse events associated with low-dose methotrexate treatment in patients with rheumatoid arthritis, but it also can decrease the efficacy of the methotrexate therapy and delay the...

SSRI use may increase risk of upper GI bleeding.(Across Specialties)
March 1, 2008... A new analysis of data from observational studies and case reports as confirmed that the use of selective serotonin reuptake inhibitors is associated with an increased risk of upper gastrointestinal hemorrhage, particularly in patients also...

Watching soccer match could spark cardio events.(Across Specialties)
March 1, 2008... Watching an important soccer match that triggered intense emotional stress more than doubled the risk of an acute cardiovascular event in a German study. Dr. Ute Wilbert-Lampen and her associates studied cardiovascular (CV) event rates in...

CellCept disappoints in large phase III lupus trial.(Across Specialties)
March 1, 2008... SNOWMASS, COLO. -- In an unexpected major disappointment, mycophenolate mofetil proved neither more effective nor less toxic than standard pulse cyclophosphamide as induction therapy in patients with lupus nephritis in a large randomized phase...

Expert favors modest dosing of toxic lupus drug.(Across Specialties)
March 1, 2008... SNOWMASS, COLO. -- Most American physicians who treat systemic lupus erythematosus have been overly slow to adopt the low-dose, less toxic minipulse intravenous cyclophosphamide regimen pioneered in the landmark Euro-Lupus Nephritis Trial, Dr....

Enbrel sales investigated.(Policy & Practice)
March 1, 2008... The New Jersey Attorney General's office is investigating Amgen for allegedly promoting Enbrel for off-label uses and for violating privacy laws to get access to potential new patients. On Jan. 14, Attorney General Anne Milgram subpoenaed Amgen...

HHS resists Ketek subpoena.(Policy & Practice)(health and human services )(Brief article)
March 1, 2008... The Department of Health and Human Services has refused to comply with a House Energy and Commerce Committee subpoena of documents related to the March 2007 testimony by Food and Drug Administration Commissioner Andrew von Eschenbach on the...

Reloxin approval delayed.(Policy & Practice)
March 1, 2008... FDA has refused to accept the biologics license application filed by Medicis Pharmaceutical Corp. for Reloxin (injectable botulinum toxin type A), according to a Securities and Exchange Commission filing by the company According to the filing,...

Eyelash lengthener sales halted.(Policy & Practice)
March 1, 2008... Jan Marini Skin Research Inc. has stopped selling its Age Intervention Eyelash Conditioner and Age Intervention Masses of Lashes Performance Mascara in the United States. The company cited its involvement in ongoing patent litigation with...

More action needed on MRSA.(Policy & Practice)
March 1, 2008... U.S. health care facilities are not doing enough to protect patients from methicillin-resistant Staphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority...

Organize your samples--and your reps.(Managing Your Dermatology Practice)(Column)
March 1, 2008... My January column, a collection of possible New Year's resolutions, generated quite a few requests for elaboration on some of the suggestions. Hopefully, the next few columns will fulfill some of those requests. The column in question, if...

Bush proposes Medicare, Medicaid cuts for 2009.(Practice Trends)
March 1, 2008... In the final budget proposal of his presidency, President Bush is planning substantial cuts to hospitals, skilled nursing facilities, and graduate medical education. Leaders in the Democrat-controlled Congress immediately declared the...

Data watch.(Practice Trends)
March 1, 2008... Adults Who Did Not Receive Needed Health Care Because They Could Not Afford It Age (years) 18-44 8.1% 45-64 7.7% [greater than or equal to] 65 2.5% Note: Based on...