b3d8f31c475d018b7b302aeb4236b544 292087.pdf 583424ef9f66298f76110d4861b210f2f8bdbb53 292087.pdf 25bac01d60a1ca4df388287fe1771e6664dfed7368e5627e3b88bd15bb7b3c0a 292087.pdf Title: Patients’ Lived Experience in a Multicomponent Intervention for Fibromyalgia Syndrome in Primary Care: A Qualitative Interview Study Subject: Fibromyalgia syndrome (FMS) disrupts patients’ biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia’s primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients’ lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients’ needs, which will hopefully increase its effectiveness and improve their quality of life. Keywords: fibromyalgia syndrome; primary care; multicomponent intervention; qualitative research; interview study; thematic analysis Author: Victoria Mailen Arfuch, Rosa Caballol Angelats, Carina Aguilar Martín, Alessandra Queiroga Gonçalves, Noèlia Carrasco-Querol, Gemma González Serra, Maria Cinta Sancho Sol, Immaculada Fusté Anguera, Emilie Friberg and Anna Berenguera Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Oct 20 01:45:35 2022 CEST ModDate: Thu Oct 20 01:49:01 2022 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 20 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 830483 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- XKFKHI+VnURWPalladioL Type 1 Custom yes yes no 10 0 LLFMXL+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 KPMWEA+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 DXJHWI+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 DPDBQY+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 LWQXII+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 LOAOMP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 84 0 LOAONB+PalatinoLinotype TrueType WinAnsi yes yes no 87 0 LOAOND+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 90 0 WABLSD+SFRM1000 Type 1 Custom yes yes no 98 0 LOAOMP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 113 0 LOAONB+PalatinoLinotype TrueType WinAnsi yes yes no 116 0 LOAOND+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 119 0 AOPHAZ+CMSY10 Type 1 Builtin yes yes no 146 0 KWLWXA+VnURWPalladioL-Italic Type 1 Custom yes yes no 156 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-16 03:11:36 CEST RepresentationInformation: 292087.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-15 17:34:28 CEST Size: 830483 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 445 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Design Destination: subsection.2.1 Item: Title: Multicomponent Intervention Program and Setting Destination: subsection.2.2 Item: Title: Population and Recruitment Destination: subsection.2.3 Item: Title: Data Collection Destination: subsection.2.4 Item: Title: Data Analysis Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Theme 1: Legitimizing Fibromyalgia through the MCI Destination: subsection.3.1 Children: Item: Title: Perceiving Fibromyalgia as a Real Health Condition Destination: subsubsection.3.1.1 Item: Title: Peers’ Pain as Living Proof of FMS Destination: subsubsection.3.1.2 Item: Title: Theme 2: The MCI as a Socialising Experience Destination: subsection.3.2 Children: Item: Title: The MCI Promotes New Encounters Destination: subsubsection.3.2.1 Item: Title: The Burden of an Unsupportive Family Destination: subsubsection.3.2.2 Item: Title: The Perceived Drawbacks of Group Settings Destination: subsubsection.3.2.3 Item: Title: Theme 3: Learning How to Live with FMS through the MCI Destination: subsection.3.3 Children: Item: Title: The MCI as an Unmasking Experience Destination: subsubsection.3.3.1 Item: Title: The MCI Improves FMS Coping Skills for Symptom Self-Management Destination: subsubsection.3.3.2 Item: Title: The MCI Promotes Self-Awareness Destination: subsubsection.3.3.3 Item: Title: The MCI as an Empowering Experience Destination: subsubsection.3.3.4 Item: Title: The MCI Triggers a Catalytic Effect Destination: subsubsection.3.3.5 Item: Title: Theme 4. Room for Improving the MCI Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Children: Item: Title: The Contributions of Social Support in Legitimizing FMS Destination: subsection.4.1 Item: Title: Monitoring Group-Based Interventions for FMS Destination: subsection.4.2 Item: Title: Learning How to Live with FMS: Overcoming Health-Related Guilt Destination: subsection.4.3 Item: Title: Understanding Health-Related Guilt in FMS from a Gender Perspective Destination: subsection.4.4 Item: Title: Learning How to Live with FMS: A Mind Body Approach Destination: subsection.4.5 Item: Title: The Multicomponent Intervention Approach in FMS Destination: subsection.4.6 Item: Title: Strengths and Limitations Destination: subsection.4.7 Item: Title: Conclusions Destination: section.5 Item: Title: Appendix A Destination: section.A. Item: Title: Appendix B Destination: section.B. Item: Title: References Destination: table.caption.4 Info: Title: Patients’ Lived Experience in a Multicomponent Intervention for Fibromyalgia Syndrome in Primary Care: A Qualitative Interview Study Author: Victoria Mailen Arfuch, Rosa Caballol Angelats, Carina Aguilar Martín, Alessandra Queiroga Gonçalves, Noèlia Carrasco-Querol, Gemma González Serra, Maria Cinta Sancho Sol, Immaculada Fusté Anguera, Emilie Friberg and Anna Berenguera Subject: Fibromyalgia syndrome (FMS) disrupts patients’ biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia’s primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients’ lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients’ needs, which will hopefully increase its effectiveness and improve their quality of life. Keywords: fibromyalgia syndrome; primary care; multicomponent intervention; qualitative research; interview study; thematic analysis Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Oct 20 01:45:35 CEST 2022 ModDate: Thu Oct 20 01:49:01 CEST 2022 ID: 0x2b66e5dd357225958109fe7bfd57c06d, 0x2b66e5dd357225958109fe7bfd57c06d Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WABLSD+SFRM1000 FontSubset: true FirstChar: 180 LastChar: 180 FontDescriptor: FontName: WABLSD+SFRM1000 Flags: Symbolic FontBBox: -189, -321, 1456, 937 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: AOPHAZ+CMSY10 FontSubset: true FirstChar: 48 LastChar: 48 FontDescriptor: FontName: AOPHAZ+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: KPMWEA+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: KPMWEA+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DXJHWI+URWPalladioL-Ital FontSubset: true FirstChar: 39 LastChar: 150 FontDescriptor: FontName: DXJHWI+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: XKFKHI+VnURWPalladioL FontSubset: true FirstChar: 160 LastChar: 242 FontDescriptor: FontName: XKFKHI+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DPDBQY+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 189 FontDescriptor: FontName: DPDBQY+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KWLWXA+VnURWPalladioL-Italic FontSubset: true FirstChar: 160 LastChar: 226 FontDescriptor: FontName: KWLWXA+VnURWPalladioL-Italic Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: LLFMXL+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 231 FontDescriptor: FontName: LLFMXL+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 57, 335, 152, 344 Annotation: Subtype: Link Rect: 34, 323, 86, 332 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 180, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 166, 642, 178, 655 Annotation: Subtype: Link Rect: 193, 629, 204, 643 Annotation: Subtype: Link Rect: 322, 629, 333, 643 Annotation: Subtype: Link Rect: 205, 17, 354, 28 Annotation: Subtype: Link Rect: 416, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 480, 87, 499 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 474, 695, 481, 704 ActionDest: 163 Annotation: Subtype: Link Rect: 482, 695, 489, 704 ActionDest: 163 Annotation: Subtype: Link Rect: 480, 670, 487, 679 ActionDest: 163 Annotation: Subtype: Link Rect: 229, 632, 236, 641 ActionDest: 163 Annotation: Subtype: Link Rect: 224, 607, 231, 616 ActionDest: 163 Annotation: Subtype: Link Rect: 464, 607, 471, 616 ActionDest: 163 Annotation: Subtype: Link Rect: 472, 607, 479, 616 ActionDest: 163 Annotation: Subtype: Link Rect: 242, 582, 249, 591 ActionDest: 163 Annotation: Subtype: Link Rect: 249, 582, 256, 591 ActionDest: 163 Annotation: Subtype: Link Rect: 367, 557, 378, 566 ActionDest: 163 Annotation: Subtype: Link Rect: 513, 544, 524, 553 ActionDest: 163 Annotation: Subtype: Link Rect: 528, 544, 540, 553 ActionDest: 163 Annotation: Subtype: Link Rect: 258, 532, 270, 541 ActionDest: 163 Annotation: Subtype: Link Rect: 269, 519, 281, 528 ActionDest: 163 Annotation: Subtype: Link Rect: 487, 481, 499, 490 ActionDest: 163 Annotation: Subtype: Link Rect: 499, 481, 511, 490 ActionDest: 163 Annotation: Subtype: Link Rect: 263, 431, 275, 440 ActionDest: 163 Annotation: Subtype: Link Rect: 269, 368, 281, 377 ActionDest: 163 Annotation: Subtype: Link Rect: 284, 369, 296, 377 ActionDest: 163 Annotation: Subtype: Link Rect: 364, 331, 376, 340 ActionDest: 163 Annotation: Subtype: Link Rect: 377, 331, 389, 340 ActionDest: 163 Annotation: Subtype: Link Rect: 388, 256, 400, 264 ActionDest: 163 Annotation: Subtype: Link Rect: 403, 256, 415, 264 ActionDest: 163 Annotation: Subtype: Link Rect: 426, 230, 438, 239 ActionDest: 166 Annotation: Subtype: Link Rect: 374, 193, 381, 202 ActionDest: 163 Annotation: Subtype: Link Rect: 381, 193, 393, 202 ActionDest: 166 Annotation: Subtype: Link Rect: 393, 193, 405, 202 ActionDest: 166 Annotation: Subtype: Link Rect: 469, 180, 481, 189 ActionDest: 163 Annotation: Subtype: Link Rect: 481, 180, 493, 189 ActionDest: 163 Annotation: Subtype: Link Rect: 494, 180, 506, 189 ActionDest: 166 Annotation: Subtype: Link Rect: 509, 180, 521, 189 ActionDest: 166 Annotation: Subtype: Link Rect: 345, 155, 357, 164 ActionDest: 166 Annotation: Subtype: Link Rect: 370, 130, 381, 139 ActionDest: 166 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 284, 597, 296, 606 ActionDest: 166 Annotation: Subtype: Link Rect: 305, 585, 317, 594 ActionDest: 166 Annotation: Subtype: Link Rect: 544, 533, 556, 542 ActionDest: 166 Annotation: Subtype: Link Rect: 367, 307, 379, 316 ActionDest: 166 Annotation: Subtype: Link Rect: 379, 307, 391, 316 ActionDest: 166 Annotation: Subtype: Link Rect: 461, 304, 469, 316 ActionDest: 160 Annotation: Subtype: Link Rect: 522, 91, 529, 103 ActionDest: 74 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 548, 157, 558, 169 ActionDest: 160 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 417, 597, 429, 606 ActionDest: 166 Annotation: Subtype: Link Rect: 430, 597, 442, 606 ActionDest: 166 Annotation: Subtype: Link Rect: 240, 522, 252, 531 ActionDest: 166 Annotation: Subtype: Link Rect: 264, 308, 276, 317 ActionDest: 166 Annotation: Subtype: Link Rect: 473, 308, 485, 317 ActionDest: 166 Annotation: Subtype: Link Rect: 234, 283, 241, 292 ActionDest: 103 Annotation: Subtype: Link Rect: 239, 255, 246, 267 ActionDest: 103 Page: Sequence: 6 Page: Sequence: 7 Page: Sequence: 8 Page: Sequence: 9 Page: Sequence: 10 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 278, 172, 290, 181 ActionDest: 166 Annotation: Subtype: Link Rect: 432, 135, 444, 144 ActionDest: 163 Annotation: Subtype: Link Rect: 533, 85, 545, 94 ActionDest: 166 Annotation: Subtype: Link Rect: 376, 59, 388, 69 ActionDest: 166 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 275, 635, 287, 644 ActionDest: 166 Annotation: Subtype: Link Rect: 544, 497, 556, 506 ActionDest: 166 Annotation: Subtype: Link Rect: 246, 472, 258, 481 ActionDest: 166 Annotation: Subtype: Link Rect: 259, 472, 271, 481 ActionDest: 166 Annotation: Subtype: Link Rect: 453, 472, 465, 481 ActionDest: 166 Annotation: Subtype: Link Rect: 531, 346, 543, 355 ActionDest: 166 Annotation: Subtype: Link Rect: 544, 346, 556, 355 ActionDest: 166 Annotation: Subtype: Link Rect: 188, 296, 200, 305 ActionDest: 169 Annotation: Subtype: Link Rect: 368, 271, 379, 280 ActionDest: 166 Annotation: Subtype: Link Rect: 545, 220, 556, 229 ActionDest: 169 Annotation: Subtype: Link Rect: 456, 170, 468, 179 ActionDest: 169 Annotation: Subtype: Link Rect: 469, 170, 481, 179 ActionDest: 169 Annotation: Subtype: Link Rect: 349, 145, 361, 154 ActionDest: 169 Annotation: Subtype: Link Rect: 483, 145, 495, 154 ActionDest: 169 Annotation: Subtype: Link Rect: 217, 82, 229, 91 ActionDest: 169 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 305, 707, 317, 716 ActionDest: 169 Annotation: Subtype: Link Rect: 484, 682, 496, 691 ActionDest: 169 Annotation: Subtype: Link Rect: 496, 682, 508, 691 ActionDest: 169 Annotation: Subtype: Link Rect: 312, 670, 324, 679 ActionDest: 169 Annotation: Subtype: Link Rect: 544, 644, 556, 654 ActionDest: 169 Annotation: Subtype: Link Rect: 325, 619, 337, 629 ActionDest: 169 Annotation: Subtype: Link Rect: 520, 607, 532, 616 ActionDest: 163 Annotation: Subtype: Link Rect: 483, 594, 495, 603 ActionDest: 163 Annotation: Subtype: Link Rect: 496, 594, 508, 603 ActionDest: 169 Annotation: Subtype: Link Rect: 200, 544, 212, 553 ActionDest: 163 Annotation: Subtype: Link Rect: 213, 544, 225, 553 ActionDest: 169 Annotation: Subtype: Link Rect: 316, 532, 328, 541 ActionDest: 169 Annotation: Subtype: Link Rect: 331, 532, 343, 541 ActionDest: 169 Annotation: Subtype: Link Rect: 514, 532, 526, 541 ActionDest: 169 Annotation: Subtype: Link Rect: 332, 469, 344, 478 ActionDest: 169 Annotation: Subtype: Link Rect: 478, 431, 490, 440 ActionDest: 169 Annotation: Subtype: Link Rect: 543, 368, 555, 377 ActionDest: 169 Annotation: Subtype: Link Rect: 391, 356, 398, 365 ActionDest: 163 Annotation: Subtype: Link Rect: 398, 356, 410, 365 ActionDest: 169 Annotation: Subtype: Link Rect: 411, 356, 423, 365 ActionDest: 169 Annotation: Subtype: Link Rect: 334, 318, 346, 327 ActionDest: 169 Annotation: Subtype: Link Rect: 334, 306, 346, 315 ActionDest: 169 Annotation: Subtype: Link Rect: 433, 268, 444, 277 ActionDest: 169 Annotation: Subtype: Link Rect: 356, 230, 368, 239 ActionDest: 169 Annotation: Subtype: Link Rect: 369, 230, 381, 239 ActionDest: 169 Annotation: Subtype: Link Rect: 219, 155, 231, 164 ActionDest: 169 Annotation: Subtype: Link Rect: 234, 155, 246, 164 ActionDest: 169 Annotation: Subtype: Link Rect: 361, 155, 373, 164 ActionDest: 169 Annotation: Subtype: Link Rect: 343, 117, 355, 126 ActionDest: 169 Annotation: Subtype: Link Rect: 227, 67, 239, 76 ActionDest: 169 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 188, 622, 200, 631 ActionDest: 166 Annotation: Subtype: Link Rect: 427, 610, 438, 619 ActionDest: 172 Annotation: Subtype: Link Rect: 439, 610, 451, 619 ActionDest: 172 Annotation: Subtype: Link Rect: 479, 572, 491, 581 ActionDest: 163 Annotation: Subtype: Link Rect: 318, 497, 330, 506 ActionDest: 172 Annotation: Subtype: Link Rect: 545, 433, 557, 443 ActionDest: 172 Page: Sequence: 15 Page: Sequence: 16 Page: Sequence: 17 Annotations: Annotation: Subtype: Link Rect: 91, 708, 128, 718 Annotation: Subtype: Link Rect: 134, 708, 170, 718 Annotation: Subtype: Link Rect: 188, 684, 226, 695 Annotation: Subtype: Link Rect: 232, 684, 268, 695 Annotation: Subtype: Link Rect: 109, 662, 146, 672 Annotation: Subtype: Link Rect: 152, 662, 188, 672 Annotation: Subtype: Link Rect: 260, 638, 298, 649 Annotation: Subtype: Link Rect: 299, 615, 335, 626 Annotation: Subtype: Link Rect: 478, 592, 515, 603 Annotation: Subtype: Link Rect: 521, 592, 557, 603 Annotation: Subtype: Link Rect: 262, 570, 299, 580 Annotation: Subtype: Link Rect: 305, 570, 341, 580 Annotation: Subtype: Link Rect: 185, 547, 223, 557 Annotation: Subtype: Link Rect: 292, 511, 330, 522 Annotation: Subtype: Link Rect: 336, 511, 372, 522 Annotation: Subtype: Link Rect: 59, 489, 96, 499 Annotation: Subtype: Link Rect: 59, 432, 96, 442 Annotation: Subtype: Link Rect: 102, 432, 138, 442 Annotation: Subtype: Link Rect: 178, 409, 216, 419 Annotation: Subtype: Link Rect: 222, 409, 258, 419 Annotation: Subtype: Link Rect: 510, 396, 547, 407 Annotation: Subtype: Link Rect: 175, 374, 213, 384 Annotation: Subtype: Link Rect: 86, 351, 124, 361 Annotation: Subtype: Link Rect: 291, 328, 329, 338 Annotation: Subtype: Link Rect: 131, 282, 168, 292 Annotation: Subtype: Link Rect: 310, 258, 348, 269 Annotation: Subtype: Link Rect: 86, 236, 124, 246 Annotation: Subtype: Link Rect: 130, 236, 166, 246 Annotation: Subtype: Link Rect: 232, 213, 269, 223 Annotation: Subtype: Link Rect: 276, 213, 312, 223 Annotation: Subtype: Link Rect: 372, 189, 410, 200 Annotation: Subtype: Link Rect: 416, 189, 452, 200 Annotation: Subtype: Link Rect: 59, 167, 96, 177 Annotation: Subtype: Link Rect: 246, 133, 284, 143 Annotation: Subtype: Link Rect: 396, 109, 433, 120 Annotation: Subtype: Link Rect: 288, 86, 325, 97 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 146, 711, 184, 721 Annotation: Subtype: Link Rect: 485, 687, 523, 698 Annotation: Subtype: Link Rect: 454, 664, 492, 675 Annotation: Subtype: Link Rect: 479, 606, 516, 617 Annotation: Subtype: Link Rect: 521, 606, 557, 617 Annotation: Subtype: Link Rect: 348, 583, 385, 594 Annotation: Subtype: Link Rect: 392, 583, 428, 594 Annotation: Subtype: Link Rect: 378, 549, 416, 560 Annotation: Subtype: Link Rect: 422, 549, 458, 560 Annotation: Subtype: Link Rect: 59, 515, 96, 525 Annotation: Subtype: Link Rect: 477, 503, 560, 514 Annotation: Subtype: Link Rect: 56, 491, 509, 502 Annotation: Subtype: Link Rect: 360, 445, 398, 456 Annotation: Subtype: Link Rect: 269, 411, 306, 422 Annotation: Subtype: Link Rect: 434, 399, 472, 410 Annotation: Subtype: Link Rect: 493, 365, 531, 376 Annotation: Subtype: Link Rect: 198, 342, 236, 353 Annotation: Subtype: Link Rect: 342, 307, 560, 318 Annotation: Subtype: Link Rect: 56, 296, 176, 307 Annotation: Subtype: Link Rect: 355, 273, 392, 284 Annotation: Subtype: Link Rect: 398, 273, 434, 284 Annotation: Subtype: Link Rect: 205, 238, 242, 249 Annotation: Subtype: Link Rect: 248, 238, 285, 249 Annotation: Subtype: Link Rect: 451, 215, 488, 226 Annotation: Subtype: Link Rect: 394, 204, 432, 215 Annotation: Subtype: Link Rect: 310, 181, 348, 192 Annotation: Subtype: Link Rect: 286, 158, 323, 169 Annotation: Subtype: Link Rect: 372, 135, 409, 146 Annotation: Subtype: Link Rect: 386, 112, 423, 123 Annotation: Subtype: Link Rect: 459, 100, 496, 111 Annotation: Subtype: Link Rect: 59, 67, 96, 77 Page: Sequence: 19 Annotations: Annotation: Subtype: Link Rect: 144, 711, 182, 721 Annotation: Subtype: Link Rect: 188, 711, 224, 721 Annotation: Subtype: Link Rect: 189, 687, 227, 698 Annotation: Subtype: Link Rect: 233, 687, 269, 698 Annotation: Subtype: Link Rect: 322, 664, 360, 675 Annotation: Subtype: Link Rect: 437, 629, 474, 640 Annotation: Subtype: Link Rect: 164, 607, 201, 617 Annotation: Subtype: Link Rect: 208, 607, 244, 617 Annotation: Subtype: Link Rect: 455, 583, 492, 594 Annotation: Subtype: Link Rect: 498, 583, 534, 594 Annotation: Subtype: Link Rect: 231, 549, 560, 560 Annotation: Subtype: Link Rect: 56, 537, 112, 548 Annotation: Subtype: Link Rect: 99, 504, 137, 514 Annotation: Subtype: Link Rect: 143, 504, 179, 514 Annotation: Subtype: Link Rect: 431, 491, 469, 502 Annotation: Subtype: Link Rect: 341, 468, 379, 479 Annotation: Subtype: Link Rect: 385, 468, 421, 479 Annotation: Subtype: Link Rect: 95, 435, 133, 445 Annotation: Subtype: Link Rect: 139, 435, 175, 445 Annotation: Subtype: Link Rect: 442, 411, 479, 422 Annotation: Subtype: Link Rect: 340, 388, 377, 399 Annotation: Subtype: Link Rect: 519, 376, 557, 387 Annotation: Subtype: Link Rect: 59, 366, 95, 376 Annotation: Subtype: Link Rect: 154, 331, 191, 341 Annotation: Subtype: Link Rect: 197, 331, 233, 341 Annotation: Subtype: Link Rect: 59, 297, 96, 307 Annotation: Subtype: Link Rect: 102, 297, 138, 307 Annotation: Subtype: Link Rect: 372, 273, 410, 284 Annotation: Subtype: Link Rect: 451, 227, 488, 238 Annotation: Subtype: Link Rect: 494, 227, 530, 238 Annotation: Subtype: Link Rect: 278, 204, 315, 215 Annotation: Subtype: Link Rect: 186, 182, 224, 192 Annotation: Subtype: Link Rect: 230, 182, 266, 192 Annotation: Subtype: Link Rect: 326, 158, 363, 169 Annotation: Subtype: Link Rect: 369, 158, 405, 169 Annotation: Subtype: Link Rect: 460, 146, 498, 157 Annotation: Subtype: Link Rect: 504, 146, 540, 157 Annotation: Subtype: Link Rect: 378, 123, 416, 134 Annotation: Subtype: Link Rect: 422, 123, 458, 134 Annotation: Subtype: Link Rect: 296, 100, 436, 111 Annotation: Subtype: Link Rect: 473, 77, 511, 88 Page: Sequence: 20 Annotations: Annotation: Subtype: Link Rect: 519, 722, 557, 733 Annotation: Subtype: Link Rect: 59, 711, 95, 721 Annotation: Subtype: Link Rect: 346, 687, 560, 698 Annotation: Subtype: Link Rect: 56, 676, 161, 687 Annotation: Subtype: Link Rect: 341, 652, 379, 664 Annotation: Subtype: Link Rect: 385, 652, 421, 664 Checksum: 39aa800f Type: CRC32 Checksum: b3d8f31c475d018b7b302aeb4236b544 Type: MD5 Checksum: 583424ef9f66298f76110d4861b210f2f8bdbb53 Type: SHA-1 Checksum: 25bac01d60a1ca4df388287fe1771e6664dfed7368e5627e3b88bd15bb7b3c0a Type: SHA-256