Chapter 2 60 and concentration it takes to fulfill six hearing activities at theirworkplace, specifically detecting sounds, distinguishing sounds, communicating in quiet, communicating in noise, localizing sounds and being exposed to loud sounds. According to Van der Hoek-Snieders et al. (2020), we calculated a sum-score of the items. This score can range between 0 and 18. Determinants Hearing status The ability to understand speech in noisy situations was assessed with the OEC; an internet-based speech-in-noise hearing screening that is hosted by VeiligheidNL (SheikhRashid&Dreschler, 2018).The stimuli consist of a closed set of eight equally intelligible CVC words that are presented in a stationary low-pass filtered masking noise. During this tests, the stimuli and the noise are presented via headphones. After presentation of the word, the corresponding button on a computer or telephone screen should be identified. The stimulus level decreases with 2 dB after every correct response and increases with 2 dB after every incorrect response. The first stimulus is presented at an SNR of 0 dB SNR and is followed by an up-down procedure with a 2 dB step size. After the first incorrect response, twenty stimuli are presented. The outcome of the OEC can be expressed as the speech reception threshold (SRT), which is calculated by averaging the SNR of the last ten stimuli. The SRT is determined for the right and the left ear separately. For clinical purposes, the screening outcome is pass if the SRT of at least one ear is -14.9 or lower. High sensitivity and moderate specificity have been established for the OEC, taking puretone audiometry as the reference standard (Sheikh Rashid & Dreschler, 2018). Perceived workplace noise The workplace noise intensity perceived by the employees was assessed by a visual analogue scale ranging from 0 (no noise at all) to 100 (very noisy). Confounders Since NFR is a complex construct that is influenced by personal and work-related factors (Gommans et al., 2015; Van der Hoek-Snieders et al., 2020), we controlled for several personal and work-related factors in the analysis. The personal factors
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