Top five life stressors
The Top 5 Most Stressful Life Events and How to Handle Them
July 03, 2015
Everyone experiences stress, but it can be overwhelming to know how to manage it. When major life stressors come up, it’s important to have strategies to cope and relax. The top five most stressful life events include:
- Death of a loved one
- Divorce
- Moving
- Major illness or injury
- Job loss
It might feel like stress is an emotional issue – something that lives strictly inside your head. But stress can become a physical issue as well, especially when dealing with the most stressful events in life.
Your body instinctively responds to changes and perceived threats, says Francoise Adan, MD, ABIHM, Medical Director, University Hospitals Connor Whole Health. Your body reacts by releasing stress hormones, adrenaline and cortisol to switch you into fight-or-flight mode.
After experiencing stressful life events, Dr. Adan says stored-up stress can contribute to symptoms and issues related to:
- Digestive health
- Inflammation
- Immune system
- Bone density
- Sexual health
- Sleep
- Anxiety
“Day-to-day stress takes its toll on everyone,” she says. “We’re constantly bombarded by threats and changes, but because we don’t usually literally fight or run, we stay reactive. We’re bathed and flooded in stress hormones.”
When stress strikes, you can take steps to reduce the impact on your body. To alleviate symptoms and manage even the top stressors in life, Dr. Adan recommends these three steps:
1. Take Action
- Your body is primed to act, so go ahead and get physically moving.
- “Contract your muscles, release and shake it out. You can march in place or wring a towel – 30 to 60 seconds will reboot your body and return you to physical stability,” Dr. Adan says.
2. Breathe
- Hit the pause button and tune into yourself.
Consider using guided imagery and mindfulness to engage in the moment. Being present will realign the body. - “Think: ‘I am here; it is what it is.’ It’s about acceptance, not control,” she says.
3. Feel Good
- Take at least 30 seconds to just feel good. It’ll release the same endorphins you get when you exercise.
- “Think about what you’re grateful for,” Dr. Adan says. “Tap or sing along to a song. I tell my clients to keep Play-Doh at their desks and take a minute to play.”
Research shows that using this type of framework for roughly five to 10 minutes a day will improve your health, longevity and productivity. While this is particularly important following stressful life events, it’s better to make it an everyday habit.
"Not one of us can’t spare five minutes a day,” Dr. Adan says. “It’s a choice for health.”
Related Links
University Hospitals Connor Whole Health’s S.M.A.R.T.™ (Stress Management and Resilience Training) Program can provide additional tips and practices for managing even the most stressful life events.
It’s an eight-week series led by experts on stress resilience.
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Tags: Stress, Anxiety
Top 10 Stressors In Life And Why
Stress is an inevitable part of life, and it’s not always bad.
Stress is your body’s natural response to challenging or difficult experiences. It can be triggered by positive things, such as a tricky puzzle, or negative things, such as financial difficulty.
When you’re stressed, your body goes into “fight or flight mode” — a state where your body and mind are alert. When managed in a healthy way, stress can help you perform better.
A life stressor is any event or experience that causes stress. Some stressors can be small and relatively easy to manage, like a busy day at work or a small disagreement with a loved one. Other stressors can be harder to manage, like bereavement, divorce, or becoming severely ill.
Although everybody experiences stress differently, experts have identified the top life stressors. These common stressors are most likely to contribute to anxiety.
What are the most stressful life events one can experience? It’s difficult to quantify stress, especially because we all experience stress differently.
The Holmes-Rahe Stress Scale, also known as the Social Readjustment Rating Scale, is a list of stressful life events. First developed in 1967, this stress inventory attributes points to different life stressors. According to the scale, the more points you accumulate over a year, the more likely you are to experience health issues.
However, there are some criticisms of this scale. The way we cope with stressors depends on many factors, including your individual circumstances, your cultural context, and how much support you’re receiving from others.
Remember that the Holmes-Rahe Stress Scale was created to predict illness — the purpose is not to compare your stressors to others’ or to downplay the other stressors in your life.
Stress is subjective, and you might find it harder to cope with stressors that aren’t listed here than those that are. For example, you might find it harder to cope in the aftermath of a violent crime than with your divorce. And that’s okay.
1. Death of a spouse
When your life is deeply intertwined with a person, losing them can be agonizing and can even lead to decreased life expectancy. When you lose a spouse, you might also experience other changes — your lifestyle, daily routines, and living arrangements might change. These changes can make it harder to cope in the aftermath of your spouse’s death.
If you lost a spouse or life partner, give yourself time to grieve. It might be wise to join a support group for grief or speak with a therapist who offers bereavement counseling.
2. Divorce
Even if you know it’s for the best, divorce can be difficult to deal with, especially because it often requires you to readjust your routine and lifestyle. Legal difficulties, custody battles, and moving can compound this stress.
It’s common to feel lost after a divorce. You might feel a mixture of emotions, including relief, grief, and loneliness. But it’s possible to make it through to the other side.
3. Marital separation
Like divorce, marital separation can disrupt your life as you know it. Although it might be a wise choice, separating from your spouse can be deeply stressful. Even if you’re already undergoing marital counseling, you may want to see a therapist during this period.
4. Being incarcerated
Being in jail or prison is considered a major life stressor. Incarceration can be deeply traumatic, as it is a complete disruption of your current life and routine.
Incarcerated people might also face the following stressors:
- loneliness
- isolation
- lack of productive activities
- lack of access to medical treatment
- violence and abuse
- human rights violations
- lack of access to adequate nutrition
Formerly incarcerated people might experience post-traumatic stress disorder (PTSD)-like symptoms, often called post-incarceration syndrome.
5. Death of a close family member
The loss of a loved one is often difficult to comprehend and cope with. The death of a close family member, such as a sibling, parent, or child is considered one of the most stressful life events.
6. Major personal injury or illness
A major personal injury or illness can be a significant cause of distress. Becoming ill, whether temporarily or chronically, can disrupt your routine, lifestyle, and life plans.
Your illness or injury might require you to learn to adjust to a new way of living. Being diagnosed with a life-threatening illness can also be extremely scary. Expensive medical bills can compound the stress.
7. Marriage
Marriage is generally thought of as a happy occassion, but it can also be stressful. It might require a great deal of adjustment, especially if you didn’t co-habitate with your partner beforehand. The legal and financial admin can add to the stress.
8. Being fired or laid off from work
Losing your job can be a huge source of stress.
This could cause financial anxiety — and for many people, a loss of identity. Many people identify with their jobs, and experience shame and depression when they lose that occupation.
After being fired, this stress can be compounded by financial worries and the emotional rollercoaster of job hunting.
9. Marital reconciliation
As with marriage, marital reconciliation is usually thought of as a positive thing. This might be so, but reconciling with your spouse after a separation can still require a lot of adjustment and thus be stressful.
10. Retirement
Although many of us look forward to our retirement, it can cause you to feel upheaved. When you’re used to working, it might be difficult to adjust to retirement. You might experience social isolation and a loss of purpose. You might also miss your routine and the excitement of working towards a goal.
“Retirement depression” is not uncommon, but it can be overcome. In fact, research from 2018 has found that retirement can improve your overall mental health and life satisfaction.
Focus on filling your days with meaningful, enjoyable activities and make an effort to maintain healthy habits.
Although it’s difficult to quantify stress, experts have identified common life stressors that can have an impact on your health.
Any major change or trauma can have a negative impact on your mental health. If you’re finding it hard to cope with stressors — whether they’re listed here or not — you might benefit from speaking with a therapist.
Five major scientific and medical discoveries about stress in the big city
Komsomolskaya Pravda
geneticist Ancha Baranova
Well-known geneticist, doctor of biological sciences Ancha Baranova. Photo: From the personal archive
- Let's imagine a slide, - offers Doctor of Biological Sciences, Head of the Center for the Study of Chronic Metabolic Diseases of the School of Systems Biology (USA), Director of Science at the Atlas Biomedical Holding Ancha Baranova. - Waking up in the morning, we are usually at the foot of the left slope - here is peace and lack of stress.
In fact, such a life with a constant calm would be boring. At the top of the mountain is a zone of good stress, or, in scientific terms, eustress. It stimulates us, makes life rich, invigorates. But in a big city, we, as a rule, quickly begin to slide down the right side of the mountain, into the zone of bad stress (distress). Nervous work, traffic jams, exams are pushing for this. Due to distress, fatigue begins, then exhaustion, burnout, chronic fatigue, and eventually serious diseases develop.
Therefore, our task is to stay on top of the mountain or climb back and forth from the zone of bad stress. At the same time, the border between beneficial eustress and harmful distress is literally drawn in the sand. How to recognize it and not fall into distress is not even a question for a million, but for a billion. Fortunately, approaches have already been outlined and means are emerging for its solution.
Slide from Anchi Baranova's presentation
A well-known geneticist spoke about five scientific and medical discoveries that can help to reliably measure the level of stress and reduce it.
1. WENT TO THE FITNESS GYM - EARNED DISTRESS
First of all, it is important to know the enemy by sight - to understand what harmful stresses are in a big city. Usually we complain that environmental factors “strain” us: noisy, a lot of people, a flurry of information.
- In addition, there are physiological stresses. For example, when an unpleasant substance smells bad, and it constantly irritates you - say, the smell of tobacco for non-smokers, - explains Ancha Baranova. - By the way, physical exercises also belong to such stresses. You shouldn’t think that if you haven’t been to the gym for a hundred years, and then suddenly rushed and spent three hours on the simulators, then you’ve improved your health very well. In fact, you will feel pretty bad the next day because you've been under a lot of stress. If you go to the gym every day or at least once a week, then the load for the body is more familiar, distress decreases and tends to be useful - eustress.
Another type of "pests" is psychological stress. Often they wave their hand at them - they say, experiences are only in your head, don't worry, and everything will be fine. However, science has proven that psychological stress - due to illness, troubles in the family or at work, when passing exams, watching political or criminal programs on TV - all these are real stress loads that seriously affect the body.
Slide from Ancha Baranova's presentation
2. SCANDALISTS DAMAGE OUR DNA
- If someone scolded you at work, then this person ... really damaged your brain. As well as other cells of the body, - half-jokingly, half-seriously, doctor of biological sciences Ancha Baranova warns and explains: - No matter what happens to us, during any stress in the body, the production of reactive oxygen species (ROS) increases. They damage our DNA.
However, oddly enough, a little ROS is useful: it triggers the very eustress that we need for cheerfulness, so that it is not boring and not interesting.
And speaking seriously and looking deeper, a small amount of ROS, while moderately damaging cells, stimulates defense mechanisms and increases resistance to more severe damage ( , that is, it works like hardening. - Auth.). If there is too much ROS, the cells do not have time to engage in “self-repair”, they are irreparably damaged and eventually die.
“This kind of cell death is called apoptosis, and within reasonable limits, it's actually not that bad,” the expert reassures. “In the course of apoptosis, hundreds of thousands of cells are constantly dying in our bodies, while there is no inflammation, some cells die, others are born, renewal is underway.” However, it is important that there is no strong bias towards dying cells compared to "newborns". Such an imbalance can occur with long and / or too much distress and threatens health problems up to serious illnesses.
Slide from Ancha Baranova's presentation
3. KNOW-HOW: HOW TO MEASURE THE LEVEL OF STRESS
- Finding a reliable way to measure the level of stress is very important in order to find out: what best helps in general, as well as a particular person, to reduce harmful stress , - explains Ancha Baranova.
- Relatively speaking, you eat a couple of oranges, measure the level of stress before and after, and then walk in the fresh air or enjoy shopping - and we can compare which method works more effectively.
Finding a universal meter, however, was not so easy. In theory, it would be possible to focus on the number of ROS that “shoot out” under stress. However, there are more than 200 types of such forms, plus about 15 more types of protection against them in the body, which must be taken into account in the calculations. Scientists have found this way out:
- When reactive oxygen species formed during stress damage our DNA, as a result of a chemical reaction, a so-called "non-standard" nucleotide is formed - a substance called 8-oxo-dG , says Professor Baranova. - It is its amount that can be measured in human blood in order to reliably determine the level of stress.
By the way, we can be proud: it was Russian scientists who developed this approach - the measurement of 8-oxo-dG in the blood (specifically, in the DNA residues of cells that died from stress floating in the bloodstream).
The know-how was created by a scientific team led by Natalya Veiko from the Medical Genetic Research Center at Kashirka with the participation of our expert Anchi Baranova.
4. AFFECTED CELLS “PASS THE BAKE” TO OTHERS
- A curious fact has been discovered in the course of research: a by-product of damage to our DNA - the mentioned substance 8-oxo-dG - is not only a marker-measurement of stress levels, but also itself serves as a stress factor! - continues the expert. - It turned out that this substance, released by the affected cells, is transmitted along with the bloodstream to other, still healthy ones, and the process of damage also starts in them. Thus, stress that has affected some part of our body spreads further.
A simple real-life example: you are frying scrambled eggs for breakfast and you accidentally burn your hand on the frying pan. Specific skin cells of the finger were really affected, but if the burn is very strong, then the condition of the person as a whole will worsen.
Because burned cells signal to others that damage has occurred. And one of these signals-transmitters of disturbing information is just 8-oxo-dG, released by the first affected cells.
IMPORTANT
May have found the key to getting rid of the severe side effects of cancer
- This discovery helps explain, in particular, the severe side effects of chemotherapy in cancer treatment, says Ancha Baranova. - Drugs destroy tumor cells, when they die, a large amount of 8-oxo-dG is released, and this becomes a strong stress factor that damages healthy cells.
However, there is good news: plasmapheresis can become a solution to the problem ( purification of blood from certain components by filtration. - Auth.). The researchers suggest that if a patient undergoes such a procedure after chemotherapy and removes 8-oxo-dG ejected by oncocells from the blood, then dangerous side effects can be avoided or at least greatly reduced.
This saving concept was also proposed by Russian scientists, work in this direction is already underway.
- We can talk not only about cancer patients, - adds Ancha Baranova. Many people suffer from some type of chronic disease. Almost all such diseases are accompanied by chronic apoptosis - continuous mass self-destruction of cells due to stress. Therefore, therapy by "cleansing" the main stress factor (8-oxo-dG) from the blood can be developed and used for various serious diseases.
5. MONITOR STRESS LIKE PRESSURE
doctors.
- A blood test to measure the 8-oxo-dG marker taken from you today will signal the level of stress over the past day, no more. And every day, of course, you don’t run into the laboratory for blood donation, - Ancha Baranova makes a helpless gesture. Her scientific team has developed know-how for this case too: - We came up with a convenient way, all the components already exist, it remains to bring them together and debug in an engineering way, - says the researcher.
It is expected that within the next 5 years there will be a unique biochip that will be attached to the skin like the current patches for smokers (devices similar to patch ). Now these patches contain a lot of microneedles that gradually release nicotine (to gradually get rid of addiction. - Auth.). “If these microneedles can supply something inside the body, then they can also be configured to gradually take microdroplets of blood and constantly measure the level of damaged DNA,” our expert explains. - Then the patch will send the indicators to the smartphone, you will see the figure of the total stress for the day on the screen. And you can check whether this or that way of dealing with stress that you tried today is good for you. And if the stress indicator turns out to be greatly elevated for a long time - for several weeks, then it's time to run to the doctor. Because this is an alarming signal: the scale of damage and cell death is much higher than normal.
So in the near future we will be able to monitor our health quite simply, effectively and accurately in a big city,” Ancha Baranova pleases.
TO THE TOPIC
Parents suffered - the child will be lucky
A striking discovery was made by our compatriots - a married couple scientists Tatyana and Valery Glazko. They studied cows that survived the Chernobyl disaster. It turned out: after the strongest stress - radiation damage - in the first generation, the offspring of horned ones decreased sharply. That is, irradiated cows gave birth to significantly fewer calves than usual. At the same time, newborns turned out to have genotypes that are resistant to stress! And in the future, when they began to breed in the same infected area, the number of calves was born as usual, in a healthy environment.
Slide from Ancha Baranova's presentation
- This is how a revolutionary discovery was made: in the very early stages of pregnancy, even before the implantation of the embryo (, that is, before the fertilized egg is attached to the walls of the uterus.
- Auth.), natural selection occurs in large animals on the basis of stress resistance, - says Ancha Baranova. “Man is one of those animals. And in practice, this means: if mom and dad live in a big city and constantly suffer from stress, then, as a rule, they give birth to children with increased stress resistance. Such descendants will be much better adapted to life in the metropolis.
The secret is in the very natural selection: a woman becomes pregnant in natural conditions only if, during fertilization, an embryo with a stress-resistant set of genes was formed. If the embryo does not have such “strong” genes, it simply does not survive - it does not attach to the walls of the uterus, and pregnancy does not occur.
QUESTION-EDGE
How to get rid of harmful stress as soon as possible?
- All those methods that you enjoy help to “digest” stress, - answers Ancha Baranova. - This is delicious food - it is desirable, of course, also healthy, so that in the fight against stress you do not gain extra pounds and do not harm the body.
Dancing, sports, pleasant conversation with friends.
By the way, there is scientific data on alcohol: if you use it in reasonable amounts and in the absence of contraindications, then ethanol acts as a stress-protection trainer for our cells. That is, the body as a whole becomes more resistant to damage. And this "protection" is valid for about 36 hours. Therefore, for example, people who get injured after a small dose of alcohol usually suffer less than those who are always sober. And even after heart attacks, those who on the eve of the day slightly “took on their chest” survive more often.
Important: the "anti-stress effect" works only with moderate use of quality alcohol. Based on the recommendations of the World Health Organization , is no more than one glass of dry wine per day for women and up to two glasses for men. At the same time, at least two days a week, you must adhere to the “dry law”.
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Psychology of stress: theory and practice
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32 841.92] /Contents 184 0R /group> /Tabs /S /StructParents 42 >> endobj 49 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 185 0R /group> /Tabs /S /StructParents 43 >> endobj 50 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 186 0 R /group> /Tabs /S /StructParents 44 >> endobj 51 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 187 0 R /group> /Tabs /S /StructParents 45 >> endobj 52 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 188 0 R /group> /Tabs /S /StructParents 46 >> endobj 53 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 189 0 R /group> /Tabs /S /StructParents 47 >> endobj 54 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 190 0 R /group> /Tabs /S /StructParents 48 >> endobj 55 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.
32 841.92] /Contents 191 0 R /group> /Tabs /S /StructParents 49 >> endobj 56 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 192 0 R /group> /Tabs /S /StructParents 50 >> endobj 57 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 193 0 R /group> /Tabs /S /StructParents 51 >> endobj 58 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 194 0R /group> /Tabs /S /StructParents 52 >> endobj 59 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 195 0R /group> /Tabs /S /StructParents 53 >> endobj 60 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 196 0 R /group> /Tabs /S /StructParents 54 >> endobj 61 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 197 0 R /group> /Tabs /S /StructParents 55 >> endobj 62 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.
32 841.92] /Contents 198 0 R /group> /Tabs /S /StructParents 56 >> endobj 63 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 199 0R /group> /Tabs /S /StructParents 57 >> endobj 64 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 200 0R /group> /Tabs /S /StructParents 58 >> endobj 65 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 201 0 R /group> /Tabs /S /StructParents 59 >> endobj 66 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 202 0 R /group> /Tabs /S /StructParents 60 >> endobj 67 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 203 0R /group> /Tabs /S /StructParents 61 >> endobj 68 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 204 0 R /group> /Tabs /S /StructParents 62 >> endobj 69 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.
32 841.92] /Contents 205 0 R /group> /Tabs /S /StructParents 63 >> endobj 70 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 206 0R /group> /Tabs /S /StructParents 64 >> endobj 71 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 207 0 R /group> /Tabs /S /StructParents 65 >> endobj 72 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 208 0R /group> /Tabs /S /StructParents 66 >> endobj 73 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 209 0 R /group> /Tabs /S /StructParents 67 >> endobj 74 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 210 0 R /group> /Tabs /S /StructParents 68 >> endobj 75 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 211 0 R /group> /Tabs /S /StructParents 69 >> endobj 76 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.
32 841.92] /Contents 212 0 R /group> /Tabs /S /StructParents 70 >> endobj 77 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 213 0 R /group> /Tabs /S /StructParents 71 >> endobj 78 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 214 0 R /group> /Tabs /S /StructParents 72 >> endobj 79 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 215 0 R /group> /Tabs /S /StructParents 73 >> endobj 80 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 216 0 R /group> /Tabs /S /StructParents 74 >> endobj 81 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 217 0 R /group> /Tabs /S /StructParents 75 >> endobj 82 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 218 0 R /group> /Tabs /S /StructParents 76 >> endobj 83 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.
32 841.92] /Contents 219 0 R /group> /Tabs /S /StructParents 77 >> endobj 84 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 220 0R /group> /Tabs /S /StructParents 78 >> endobj 85 0 obj > /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 221 0R /group> /Tabs /S /StructParents 79 >> endobj 86 0 obj > /ExtGState> /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 222 0R /group> /Tabs /S /StructParents 80 >> endobj 87 0 obj > /ExtGState> /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.32 841.92] /Contents 223 0 R /group> /Tabs /S /StructParents 81 >> endobj 88 0 obj > /ExtGState> /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 224 0 R /group> /Tabs /S /StructParents 82 >> endobj 89 0 obj > /ExtGState> /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox [0 0 595.32 841.92] /Contents 225 0 R /group> /Tabs /S /StructParents 83 >> endobj 90 0 obj > /ExtGState> /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] >> /MediaBox[0 0 595.
