08c1c688bd553e7006a8d04d93ed6c9f pmc_10346587.pdf 35fcb714d26cbf86fd917caffece72662a635383 pmc_10346587.pdf 048376204bcc00cece7cff2a9f75898b999c6fa35c52d3e3a90aedc1d480ef86 pmc_10346587.pdf Title: Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment Subject: Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards. Keywords: eating disorders; professional athletes; treatment outcome; physical activity Author: Ana Ibáñez-Caparrós, Isabel Sánchez, Roser Granero, Susana Jiménez-Murcia, Magda Rosinska, Ansgar Thiel, Stephan Zipfel, Joan de Pablo, Lucia Camacho-Barcia and Fernando Fernandez-Aranda Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Jul 3 04:48:18 2023 CEST ModDate: Mon Jul 3 04:50:51 2023 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 672413 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- MWHIBA+VnURWPalladioL Type 1 Custom yes yes no 10 0 CINICO+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 ZHEBFC+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 ODAAZV+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 ZZTQUO+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 JXPXXJ+EURM10 Type 1 Builtin yes yes no 71 0 WHXPMX+URWPalladioL-BoldItal Type 1 Custom yes yes no 84 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 102 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 106 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 110 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 114 0 BCDIEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 121 0 BCDJEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 125 0 FXXUVH+CMSY10 Type 1 Builtin yes yes no 139 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-02 02:33:39 CET RepresentationInformation: pmc_10346587.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-10-04 02:23:08 CEST Size: 672413 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 382 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: Sample Destination: subsection.2.1 Item: Title: Assessment Destination: subsection.2.2 Item: Title: Procedures Destination: subsection.2.3 Item: Title: Treatment Destination: subsection.2.4 Item: Title: Outcome Measures Destination: subsection.2.5 Item: Title: Statistical Analysis Destination: subsection.2.6 Item: Title: Results Destination: section.3 Children: Item: Title: Characteristics of the Sample Destination: subsection.3.1 Item: Title: Comparison between the Groups at Baseline Destination: subsection.3.2 Item: Title: Treatment Outcomes Destination: subsection.3.3 Item: Title: Comparison Based on the Sport Type Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Children: Item: Title: Clinical Features and Personality Traits Destination: subsection.4.1 Item: Title: Response to Treatment Destination: subsection.4.2 Item: Title: Predictive Factors of Therapeutic Success Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment Author: Ana Ibáñez-Caparrós, Isabel Sánchez, Roser Granero, Susana Jiménez-Murcia, Magda Rosinska, Ansgar Thiel, Stephan Zipfel, Joan de Pablo, Lucia Camacho-Barcia and Fernando Fernandez-Aranda Subject: Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards. Keywords: eating disorders; professional athletes; treatment outcome; physical activity Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Jul 03 04:48:18 CEST 2023 ModDate: Mon Jul 03 04:50:51 CEST 2023 ID: 0x056ce2664d19fe4365a72b1e61072d94, 0x056ce2664d19fe4365a72b1e61072d94 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: ZHEBFC+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: ZHEBFC+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: WHXPMX+URWPalladioL-BoldItal FontSubset: true FirstChar: 100 LastChar: 112 FontDescriptor: FontName: WHXPMX+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JXPXXJ+EURM10 FontSubset: true FirstChar: 11 LastChar: 31 FontDescriptor: FontName: JXPXXJ+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true Font: BaseFont: ODAAZV+URWPalladioL-Ital FontSubset: true FirstChar: 44 LastChar: 121 FontDescriptor: FontName: ODAAZV+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: MWHIBA+VnURWPalladioL FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: MWHIBA+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FXXUVH+CMSY10 FontSubset: true FirstChar: 0 LastChar: 0 FontDescriptor: FontName: FXXUVH+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: ZZTQUO+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: ZZTQUO+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: CINICO+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 241 FontDescriptor: FontName: CINICO+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 34, 292, 152, 301 Annotation: Subtype: Link Rect: 34, 282, 72, 289 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, 169, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 335, 660, 346, 674 Annotation: Subtype: Link Rect: 484, 660, 495, 674 Annotation: Subtype: Link Rect: 192, 648, 203, 661 Annotation: Subtype: Link Rect: 306, 648, 317, 661 Annotation: Subtype: Link Rect: 536, 648, 547, 661 Annotation: Subtype: Link Rect: 218, 638, 229, 649 Annotation: Subtype: Link Rect: 120, 17, 254, 28 Annotation: Subtype: Link Rect: 404, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 425, 87, 444 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 294, 695, 301, 704 ActionDest: 147 Annotation: Subtype: Link Rect: 453, 670, 460, 679 ActionDest: 147 Annotation: Subtype: Link Rect: 488, 657, 495, 666 ActionDest: 147 Annotation: Subtype: Link Rect: 370, 607, 377, 616 ActionDest: 147 Annotation: Subtype: Link Rect: 377, 607, 384, 616 ActionDest: 147 Annotation: Subtype: Link Rect: 424, 582, 431, 591 ActionDest: 147 Annotation: Subtype: Link Rect: 209, 557, 216, 566 ActionDest: 147 Annotation: Subtype: Link Rect: 203, 532, 210, 541 ActionDest: 147 Annotation: Subtype: Link Rect: 212, 532, 219, 541 ActionDest: 147 Annotation: Subtype: Link Rect: 220, 519, 232, 528 ActionDest: 147 Annotation: Subtype: Link Rect: 513, 507, 525, 516 ActionDest: 147 Annotation: Subtype: Link Rect: 528, 507, 540, 516 ActionDest: 147 Annotation: Subtype: Link Rect: 449, 481, 461, 490 ActionDest: 147 Annotation: Subtype: Link Rect: 188, 456, 200, 465 ActionDest: 147 Annotation: Subtype: Link Rect: 278, 419, 290, 428 ActionDest: 147 Annotation: Subtype: Link Rect: 336, 393, 348, 403 ActionDest: 147 Annotation: Subtype: Link Rect: 348, 393, 360, 403 ActionDest: 147 Annotation: Subtype: Link Rect: 543, 381, 555, 390 ActionDest: 147 Annotation: Subtype: Link Rect: 410, 368, 422, 377 ActionDest: 147 Annotation: Subtype: Link Rect: 423, 369, 435, 377 ActionDest: 147 Annotation: Subtype: Link Rect: 462, 356, 474, 365 ActionDest: 147 Annotation: Subtype: Link Rect: 266, 331, 278, 340 ActionDest: 147 Annotation: Subtype: Link Rect: 370, 306, 382, 315 ActionDest: 147 Annotation: Subtype: Link Rect: 374, 280, 386, 290 ActionDest: 147 Annotation: Subtype: Link Rect: 205, 255, 217, 264 ActionDest: 147 Annotation: Subtype: Link Rect: 476, 205, 488, 214 ActionDest: 147 Annotation: Subtype: Link Rect: 489, 205, 501, 214 ActionDest: 150 Annotation: Subtype: Link Rect: 198, 180, 210, 189 ActionDest: 150 Annotation: Subtype: Link Rect: 210, 180, 222, 189 ActionDest: 150 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 253, 508, 260, 517 ActionDest: 147 Annotation: Subtype: Link Rect: 440, 370, 452, 379 ActionDest: 150 Annotation: Subtype: Link Rect: 348, 307, 360, 316 ActionDest: 150 Annotation: Subtype: Link Rect: 391, 244, 403, 253 ActionDest: 150 Annotation: Subtype: Link Rect: 387, 207, 399, 216 ActionDest: 150 Annotation: Subtype: Link Rect: 219, 119, 231, 128 ActionDest: 150 Annotation: Subtype: Link Rect: 427, 81, 439, 90 ActionDest: 150 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 365, 710, 377, 719 ActionDest: 150 Annotation: Subtype: Link Rect: 337, 534, 349, 543 ActionDest: 150 Annotation: Subtype: Link Rect: 544, 497, 556, 506 ActionDest: 150 Annotation: Subtype: Link Rect: 301, 459, 313, 468 ActionDest: 150 Annotation: Subtype: Link Rect: 297, 421, 309, 430 ActionDest: 150 Annotation: Subtype: Link Rect: 429, 396, 441, 405 ActionDest: 150 Annotation: Subtype: Link Rect: 544, 396, 556, 405 ActionDest: 150 Annotation: Subtype: Link Rect: 361, 321, 373, 330 ActionDest: 150 Annotation: Subtype: Link Rect: 374, 321, 386, 330 ActionDest: 150 Annotation: Subtype: Link Rect: 304, 207, 310, 216 ActionDest: 147 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 544, 635, 556, 644 ActionDest: 150 Annotation: Subtype: Link Rect: 401, 560, 413, 568 ActionDest: 150 Annotation: Subtype: Link Rect: 480, 522, 492, 531 ActionDest: 150 Annotation: Subtype: Link Rect: 465, 358, 477, 368 ActionDest: 150 Annotation: Subtype: Link Rect: 382, 229, 389, 241 ActionDest: 81 Annotation: Subtype: Link Rect: 437, 154, 444, 166 ActionDest: 88 Page: Sequence: 6 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 462, 475, 469, 487 ActionDest: 88 Annotation: Subtype: Link Rect: 431, 217, 438, 229 ActionDest: 88 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 284, 717, 291, 729 ActionDest: 91 Annotation: Subtype: Link Rect: 252, 617, 259, 629 ActionDest: 94 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 302, 335, 309, 347 ActionDest: 91 Annotation: Subtype: Link Rect: 212, 260, 219, 272 ActionDest: 94 Annotation: Subtype: Link Rect: 201, 74, 213, 83 ActionDest: 150 Annotation: Subtype: Link Rect: 214, 74, 226, 83 ActionDest: 150 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 450, 698, 462, 707 ActionDest: 150 Annotation: Subtype: Link Rect: 463, 698, 474, 707 ActionDest: 150 Annotation: Subtype: Link Rect: 295, 673, 307, 682 ActionDest: 150 Annotation: Subtype: Link Rect: 410, 660, 422, 669 ActionDest: 150 Annotation: Subtype: Link Rect: 332, 610, 344, 619 ActionDest: 150 Annotation: Subtype: Link Rect: 345, 610, 357, 619 ActionDest: 150 Annotation: Subtype: Link Rect: 359, 585, 371, 594 ActionDest: 150 Annotation: Subtype: Link Rect: 374, 585, 386, 594 ActionDest: 153 Annotation: Subtype: Link Rect: 502, 585, 509, 594 ActionDest: 147 Annotation: Subtype: Link Rect: 510, 585, 522, 594 ActionDest: 147 Annotation: Subtype: Link Rect: 220, 535, 232, 544 ActionDest: 153 Annotation: Subtype: Link Rect: 233, 535, 245, 544 ActionDest: 153 Annotation: Subtype: Link Rect: 273, 522, 285, 531 ActionDest: 150 Annotation: Subtype: Link Rect: 398, 522, 410, 531 ActionDest: 153 Annotation: Subtype: Link Rect: 288, 484, 300, 493 ActionDest: 147 Annotation: Subtype: Link Rect: 303, 484, 314, 493 ActionDest: 147 Annotation: Subtype: Link Rect: 521, 384, 533, 393 ActionDest: 153 Annotation: Subtype: Link Rect: 461, 371, 473, 380 ActionDest: 147 Annotation: Subtype: Link Rect: 474, 371, 486, 380 ActionDest: 153 Annotation: Subtype: Link Rect: 489, 371, 501, 380 ActionDest: 153 Annotation: Subtype: Link Rect: 328, 321, 340, 330 ActionDest: 147 Annotation: Subtype: Link Rect: 294, 170, 306, 179 ActionDest: 147 Annotation: Subtype: Link Rect: 306, 170, 318, 179 ActionDest: 153 Annotation: Subtype: Link Rect: 524, 133, 536, 142 ActionDest: 147 Annotation: Subtype: Link Rect: 318, 120, 330, 129 ActionDest: 153 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 394, 619, 406, 629 ActionDest: 153 Annotation: Subtype: Link Rect: 409, 620, 421, 629 ActionDest: 153 Annotation: Subtype: Link Rect: 221, 594, 233, 603 ActionDest: 150 Annotation: Subtype: Link Rect: 376, 582, 388, 591 ActionDest: 153 Annotation: Subtype: Link Rect: 389, 582, 401, 591 ActionDest: 153 Annotation: Subtype: Link Rect: 236, 569, 248, 578 ActionDest: 153 Annotation: Subtype: Link Rect: 337, 557, 349, 566 ActionDest: 153 Annotation: Subtype: Link Rect: 544, 431, 556, 440 ActionDest: 153 Annotation: Subtype: Link Rect: 531, 381, 543, 390 ActionDest: 153 Annotation: Subtype: Link Rect: 544, 381, 556, 390 ActionDest: 153 Annotation: Subtype: Link Rect: 432, 356, 444, 365 ActionDest: 153 Annotation: Subtype: Link Rect: 310, 318, 322, 327 ActionDest: 153 Annotation: Subtype: Link Rect: 325, 318, 337, 327 ActionDest: 156 Annotation: Subtype: Link Rect: 411, 280, 423, 290 ActionDest: 156 Page: Sequence: 12 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 372, 696, 409, 707 Annotation: Subtype: Link Rect: 478, 673, 515, 684 Annotation: Subtype: Link Rect: 521, 673, 557, 684 Annotation: Subtype: Link Rect: 59, 639, 96, 649 Annotation: Subtype: Link Rect: 102, 639, 138, 649 Annotation: Subtype: Link Rect: 191, 615, 228, 626 Annotation: Subtype: Link Rect: 235, 615, 271, 626 Annotation: Subtype: Link Rect: 433, 603, 470, 614 Annotation: Subtype: Link Rect: 131, 581, 168, 591 Annotation: Subtype: Link Rect: 148, 547, 186, 557 Annotation: Subtype: Link Rect: 243, 511, 281, 522 Annotation: Subtype: Link Rect: 185, 489, 223, 499 Annotation: Subtype: Link Rect: 520, 477, 557, 488 Annotation: Subtype: Link Rect: 378, 454, 415, 465 Annotation: Subtype: Link Rect: 449, 431, 487, 442 Annotation: Subtype: Link Rect: 520, 408, 557, 419 Annotation: Subtype: Link Rect: 224, 373, 261, 384 Annotation: Subtype: Link Rect: 391, 350, 428, 361 Annotation: Subtype: Link Rect: 131, 328, 168, 338 Annotation: Subtype: Link Rect: 127, 305, 164, 315 Annotation: Subtype: Link Rect: 291, 281, 329, 292 Annotation: Subtype: Link Rect: 160, 258, 198, 269 Annotation: Subtype: Link Rect: 171, 235, 208, 246 Annotation: Subtype: Link Rect: 340, 189, 378, 200 Annotation: Subtype: Link Rect: 59, 144, 96, 154 Annotation: Subtype: Link Rect: 102, 144, 138, 154 Annotation: Subtype: Link Rect: 284, 120, 322, 131 Annotation: Subtype: Link Rect: 328, 120, 364, 131 Annotation: Subtype: Link Rect: 229, 97, 266, 108 Annotation: Subtype: Link Rect: 131, 75, 168, 85 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 210, 722, 248, 733 Annotation: Subtype: Link Rect: 337, 699, 375, 710 Annotation: Subtype: Link Rect: 237, 676, 275, 687 Annotation: Subtype: Link Rect: 261, 549, 299, 560 Annotation: Subtype: Link Rect: 402, 514, 440, 525 Annotation: Subtype: Link Rect: 157, 458, 194, 468 Annotation: Subtype: Link Rect: 326, 422, 363, 433 Annotation: Subtype: Link Rect: 179, 389, 217, 399 Annotation: Subtype: Link Rect: 353, 376, 390, 387 Annotation: Subtype: Link Rect: 95, 354, 133, 364 Annotation: Subtype: Link Rect: 458, 342, 495, 353 Annotation: Subtype: Link Rect: 104, 297, 141, 307 Annotation: Subtype: Link Rect: 403, 284, 440, 295 Annotation: Subtype: Link Rect: 346, 261, 383, 272 Annotation: Subtype: Link Rect: 296, 238, 333, 249 Annotation: Subtype: Link Rect: 59, 216, 96, 226 Annotation: Subtype: Link Rect: 95, 182, 133, 192 Annotation: Subtype: Link Rect: 139, 182, 175, 192 Annotation: Subtype: Link Rect: 59, 159, 96, 169 Annotation: Subtype: Link Rect: 520, 135, 557, 146 Annotation: Subtype: Link Rect: 266, 112, 303, 123 Annotation: Subtype: Link Rect: 109, 78, 146, 88 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 466, 733, 504, 744 Annotation: Subtype: Link Rect: 520, 710, 557, 721 Annotation: Subtype: Link Rect: 490, 687, 528, 698 Annotation: Subtype: Link Rect: 362, 664, 400, 675 Annotation: Subtype: Link Rect: 59, 630, 96, 640 Annotation: Subtype: Link Rect: 478, 618, 516, 629 Annotation: Subtype: Link Rect: 191, 572, 228, 583 Annotation: Subtype: Link Rect: 484, 560, 522, 571 Annotation: Subtype: Link Rect: 283, 537, 320, 548 Annotation: Subtype: Link Rect: 131, 515, 168, 525 Annotation: Subtype: Link Rect: 236, 492, 274, 502 Annotation: Subtype: Link Rect: 382, 468, 420, 479 Annotation: Subtype: Link Rect: 241, 445, 279, 456 Annotation: Subtype: Link Rect: 230, 423, 267, 433 Annotation: Subtype: Link Rect: 131, 400, 168, 410 Annotation: Subtype: Link Rect: 175, 400, 211, 410 Annotation: Subtype: Link Rect: 300, 376, 338, 387 Annotation: Subtype: Link Rect: 344, 376, 380, 387 Annotation: Subtype: Link Rect: 445, 353, 482, 364 Annotation: Subtype: Link Rect: 488, 353, 524, 364 Annotation: Subtype: Link Rect: 59, 320, 96, 330 Annotation: Subtype: Link Rect: 131, 297, 168, 307 Annotation: Subtype: Link Rect: 143, 274, 181, 284 Annotation: Subtype: Link Rect: 430, 250, 468, 261 Annotation: Subtype: Link Rect: 59, 216, 96, 226 Annotation: Subtype: Link Rect: 353, 192, 390, 203 Annotation: Subtype: Link Rect: 131, 159, 168, 169 Annotation: Subtype: Link Rect: 179, 124, 217, 134 Annotation: Subtype: Link Rect: 270, 100, 307, 111 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 104, 711, 142, 721 Annotation: Subtype: Link Rect: 395, 687, 432, 698 Checksum: dd841ce3 Type: CRC32 Checksum: 08c1c688bd553e7006a8d04d93ed6c9f Type: MD5 Checksum: 35fcb714d26cbf86fd917caffece72662a635383 Type: SHA-1 Checksum: 048376204bcc00cece7cff2a9f75898b999c6fa35c52d3e3a90aedc1d480ef86 Type: SHA-256