The work of leadership.

More and more companies today are facing adaptive challenges: changes in societies, markets, and technology around the globe are forcing them to clarify their values, develop new strategies, and learn new ways of operating. And the most important task for leaders in the face of such challenges is mobilizing people throughout the organization to do adaptive work. Yet for many senior executives, providing such leadership is difficult. Why? One reason is that they are accustomed to solving problems themselves. Another is that adaptive change is distressing for the people going through it. They need to take on new roles, relationships, values, and approaches to work. Many employees are ambivalent about the sacrifices required of them and look to senior executives to take problems off their shoulders. But both sets of expectations have to be unlearned. Rather than providing answers, leaders have to ask tough questions. Rather than protecting people from outside threats, leaders should let the pinch of reality stimulate them to adapt. Instead of orienting people to their current roles, leaders must disorient them so that new relationships can develop. Instead of quelling conflict, leaders should draw the issues out. Instead of maintaining norms, leaders must challenge "the way we do business" and help others distinguish immutable values from the historical practices that have become obsolete. The authors offer six principles for leading adaptive work: "getting on the balcony," identifying the adaptive challenge, regulating distress, maintaining disciplined attention, giving the work back to people, and protecting voices of leadership from below.

Intestinal parasites in Central American immigrants in the United States.

We describe the results of ova and parasite examinations of 216 Central Americans who were seen at a Los Angeles, Calif, clinic during an 8-month period. Among the 125 immigrants from Central America, intestinal parasitic prevalence was 53%. Pathogens were found in 45% and multiple pathogens in 21%. Of the 91 US born Central American children, parasite prevalence was 14%. Pathogens were found in 12%. The most common pathogens were Trichuris trichiura, Giardia lamblia, and Ascaris lumbricoides. Giardia lamblia was more prevalent in the younger than 5-year-old age group, and helminths were more prevalent in the 6- to 10-year-old age group. No helminths were found in immigrants who had been in the US for more than 3 years. Gastrointestinal symptoms did not correlate with prevalence of parasites. The high prevalence of intestinal parasites supports previous recommendations for screening; decisions for screening should be based on morbidity (probably low), efficacy and safety of treatment (good), and costs.

Parental occupation and birth outcome in an agricultural community.

The general birth outcome and prevalence of specific birth defects was investigated within an agricultural community through the review of birth records in a major hospital in Imperial County, California. Of all singleton births (N = 2 463) occurring within a four-year period, 990 or 40.2% involved offspring with one or both parent(s) who were agricultural workers. The progeny of agricultural and nonagricultural workers were similar with regard to sex ratios, prevalence of low birth-weight infants, stillbirth rate, minor and major malformation rates, and prevalence of neonatal deaths. Limb reduction defects, however, occurred more frequently among offspring of agricultural workers (5.05 per 1 000 total births versus 2.19 per 1 000 total births, rate ratio = 2.3). Furthermore, the prevalence of limb reduction defects among agricultural workers was 3- to 14-fold higher than available United States rates (0.36-1.65 per 1 000 total births). Findings from our study suggest that agricultural communities and, in particular, agricultural workers may be at excess risk of producing a child with a limb reduction defect.