Homeowners' association, housing office, housing department, housing and communal services, management company: what is it and how do they work? Diffuse euthyroid goiter: diagnosis and treatment Emergency home care

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The term "diffuse euthyroid goiter" (DEZ) refers to a visible and / or palpable enlargement of the thyroid gland.

DEZ is a general diffuse enlargement of the thyroid gland without impairing its function. The main cause of ECD is insufficient iodine content in environment and, as a consequence, its reduced consumption by the population with the usual food products. Depending on the prevalence of ECD, sporadic and endemic goiter are distinguished in the population.

A goiter is considered endemic if in the surveyed region the incidence of goiter in younger and middle-aged children school age is more than 5%. DEZ - pathology of young people. In more than 50% of cases, it develops before the age of 20, and in women, goiter develops 2-3 times more often than in men, while, as a rule, in those periods when the need for iodine is increased (puberty, pregnancy , lactation).

According to the criteria adopted by WHO, UNICEF (United Nations Children's Fund) and ICCIDD (International Council for the Control of Iodine Deficiency Disorders), a region can be considered free of iodine deficiency if the median ioduria is between 100-300 μg / L and the prevalence goiter does not exceed 5%. In Russia, there is practically no territory that is safe in terms of the risk of developing iodine-deficient goiter. According to the data of epidemiological surveys in 1991-2006, the frequency of various forms of goiter in the Russian Federation ranges from 10 to 40%.

The most common cause of DEZ development is iodine deficiency. In this case, hypertrophy and hyperplasia of the thyroid gland are of a compensatory nature and are aimed at providing the body with thyroid hormones. What are the mechanisms of such adaptation to insufficient iodine intake?

First, the absorption of iodine by the thyroid gland increases due to the enhancement of its active capture.

Secondly, there is a predominant synthesis of triiodothyronine (T3), which is the most active thyroid hormone, while its synthesis requires not 4, but only 3 iodine atoms.

Thirdly, the secretion of iodine by the kidneys decreases, the reutilization of endogenous iodine increases, which increases the efficiency of the biosynthesis of thyroid hormones.

Fourth, the iodine content in the colloid decreases (due to the predominant synthesis of monoiodotyrosine, and not diiodotyrosine) and thyroglobulin in the colloid (due to increased proteolysis).

On early stages the development of goiter (i.e., in children, adolescents and young people), compensatory hypertrophy of thyrocytes occurs. The thyroid gland is represented by a mass of small follicles that practically do not contain colloid. Such a goiter is called parenchymal; it is the result of successful adaptation.

Another morphological variant of DEZ is colloid goiter. It consists of large follicles containing a huge amount of colloid. During the formation of this type of goiter, a number of mechanisms interfere with the optimal functioning of the thyroid gland. An imbalance arises between the synthesis and hydrolysis of thyroglobulin, the degree of iodination of thyroglobulin decreases. There is a leak of iodine from the thyroid gland and a decrease in the synthesis of iodothyronines. Changes of this type prevail in the thyroid tissue of the operated patients.

There is no doubt that all adaptation reactions are stimulated and controlled by thyroid-stimulating hormone (TSH). However, as has been shown in many studies, the TSH level does not increase with ECD. In the course of a number of studies in vivo and in vitro, new data have been obtained on the autoregulation of the thyroid gland by iodine and autocrine growth factors (ARF). According to modern concepts, an increase in TSH production or an increase in the sensitivity of thyrocytes to it is only of secondary importance in the pathogenesis of iodine-deficient goiter. The main role in this is assigned to ARFs, such as insulin-like growth factor 1 (IRF-1), epidermal growth factor (ERF) and fibroblast growth factor (FGF), which, in conditions of a decrease in the iodine content in the thyroid gland, have a powerful stimulating effect on thyrocytes. It was experimentally shown that when KI was added to the culture, there was a decrease in TSH-induced, cAMP (cyclic adenosine monophosphate) -mediated expression of M-RNA IGF-1, with its complete cessation with a significant increase in the dose of iodide.

It is well known that iodine itself is not only a substrate for the synthesis of thyroid hormones, but also regulates the growth and function of the thyroid gland. The proliferation of thyrocytes is inversely related to the intrathyroid iodine content. High doses of iodine inhibit the absorption of iodine, its organization, the synthesis and secretion of thyroid hormones, the absorption of glucose and amino acids. Iodine, entering the thyrocyte, interacts not only with tyrosyl residues in thyroglobulin, but also with lipids. The resulting compounds (iodolactones and iodaldehydes) are the main physiological blockers of ARF production. In the human thyroid gland, many different iodolactones have been identified, which are formed due to the interaction of membrane polyunsaturated fatty acids (arachidonic, doxahexene, etc.) with iodine in the presence of lactoperoxidase and hydrogen peroxide.

In conditions of chronic iodine deficiency, there is a decrease in the formation of iodlipids - substances that inhibit the proliferative effects of ARF (IRF-1, FGF, ERF). In addition, with insufficient iodine content, the sensitivity of these ARFs to the growth effects of TSH increases, the production of transforming growth factor-b (TGF-b), which is normally an inhibitor of proliferation, decreases, and angiogenesis is activated.

All this leads to an enlargement of the thyroid gland, the formation of iodine-deficient goiter.

In general, the development of DEZ depends on many factors that are not fully understood. In addition to iodine deficiency, other factors related to the development of goiter include smoking, taking certain medicines, emotional stress, foci of chronic infection. Sex, age, hereditary predisposition also matter.

With endemic goiter, genetic predisposition can be realized only if there is an appropriate external factor - iodine deficiency in the environment. In the absence of a genetic predisposition, mild or even moderate iodine deficiency may not lead to the formation of a goiter, since this deficiency will be compensated for by the more efficient operation of the systems that ensure the synthesis of thyroid hormones. In severe iodine deficiency, even the maximum activation of compensatory processes cannot always prevent the formation of goiter in persons without a genetic predisposition.

To assess the degree of enlargement of the thyroid gland by palpation, WHO (2001) recommended the following classification.

Zero degree - no goiter (the volume of each lobe does not exceed the volume of the distal phalanx of the subject's thumb).

1st degree - the goiter is palpable, but not visible in the normal position of the neck. This also includes nodules that do not lead to an increase in the gland itself.

2nd degree - the goiter is clearly visible in the normal position of the neck.

The sensitivity and specificity of the palpation method for assessing the degree of goiter is rather low. Therefore, to accurately determine the size and volume of the thyroid gland as part of an epidemiological study, it is recommended to conduct an ultrasound examination (ultrasound).

The volume of the thyroid gland is calculated taking into account the width (W), length (D) and thickness (T) of each lobe and the correction factor for ellipsoidity according to the following formula

V uzh = [(W pr x D pr x T pr) + (W l x D l x T l)] x 0.479.

In adults, a goiter is diagnosed if the volume of the gland, according to ultrasound, exceeds 18 ml in women and 25 ml in men. In a child, the volume of the thyroid gland depends on the degree of physical development, therefore, before the study, the height and weight of the child are measured and the body surface area is calculated using a special scale or formula. In children, the volume of the thyroid gland is compared with the normative indicators (depending on the surface area of the body).

The clinical picture of DEZ depends on the degree of enlargement of the thyroid gland, since its function remains normal. The very fact of a slight increase in the thyroid gland with its normal function practically does not affect the work of other organs and systems. In the overwhelming majority of cases, in conditions of mild and moderate iodine deficiency, a slight increase in the thyroid gland is detected only with a targeted examination.

In conditions of severe iodine deficiency, goiter can reach gigantic proportions. Also, against the background of ECD, a nodular goiter may develop in the future, including those with autonomously functioning nodes.

DEZ treatment

Measures to eliminate iodine deficiency in the USSR were adopted thanks to epidemiological studies begun even before World War II by the outstanding endocrinologist surgeon and prevention specialist OV Nikolaev. They included the mass production of iodized table salt, the use of tablets of iodine among at-risk groups, and the creation of anti-throat dispensaries. Against the background of this program, iodine deficiency in Russia was largely overcome in the period from 1955 to 1970. After this happened, as a sign of "victory over the ECD" it was decided to gradually curtail the measures to eliminate it, and the diagnosis of "endemic goiter" replace with "thyroid hyperplasia".

In Western Europe, until the 60s of the last century, preparations of thyroid extracts were used, the effectiveness of which was determined not only by the content of thyroid hormones, but also by a large amount of iodine.

To date, there are three options for conservative therapy for DEZ:

monotherapy with levothyroxine,
monotherapy with iodine preparations,
combined therapy with iodine and levothyroxine preparations.

Monotherapy with levothyroxine has been scientifically substantiated in the treatment of ECD when describing the regulation of the thyroid gland by the hypothalamic-pituitary system. In an experiment on rats, it was shown that an artificially simulated severe iodine deficiency leads to an increase in the level of TSH, which, in turn (as well as exogenously administered TSH), can lead to the formation of goiter. It was assumed that under conditions of iodine deficiency, the synthesis and secretion of thyroxin T 4 and T 3, for which iodine is the main structural component, decrease, which, according to the principle of negative feedback, leads to an increase in TSH secretion. Therefore, the main goal of therapy with levothyroxine was to suppress TSH, which contributes to an increase in the volume of the thyroid gland (suppressive therapy). However, it has been repeatedly shown that the decrease in the volume of the gland does not depend on the degree of suppression of TSH. There are also studies proving that the average level of TSH in iodine-deficient areas is significantly lower than in areas where iodine intake is normal. Moreover, there is evidence of experimental work demonstrating that it is not possible to stimulate the growth of follicles containing a sufficient amount of iodine with the introduction of TSH.

As mentioned above, the administration of levothyroxine has been widely used to treat ECD in the past. At the same time, excellent results were achieved at the initial stage. Many clinical studies have shown that after already 3-4 months from the start of therapy, there was a significant (at least 20%) decrease in the volume of the gland. The literature provides data on the effectiveness of using various doses and combinations of thyroid hormones. Thus, T 3 at a dose of 50 mcg per day is most effective in reducing the volume of the thyroid gland. Further, as the efficiency decreases, the options follow:

(T 4 50 mcg + T 3 12.5 mcg) twice a day;
T4 150 mcg per day + iodine 150 mcg per day;
T 4 75 mcg per day + T 3 18.75 mcg per day;
T 4 200 mcg per day;
T 3 37.5 mcg per day.

The most commonly used doses in clinical practice are 150 mcg in adults and 100 mcg in adolescents. However, numerous studies have unequivocally demonstrated the "withdrawal phenomenon" - an increase in the size of the thyroid gland almost to the initial level within a short time after the cessation of treatment. This phenomenon is explained primarily by the fact that when TSH is suppressed, the activity of the Na + / I-symporter decreases, and, consequently, the active uptake of iodine by the thyroid gland decreases. Against the background of a sharp drop in the intrathyroid iodine content upon withdrawal medicinal product a new growth of the gland occurs. Also, side effects of thyroid hormone therapy include the possible occurrence of drug thyrotoxicosis, tachyarrhythmias, osteoporosis, which limits the use of this group of drugs in long-term treatment of ECD. However, sometimes in order to quickly achieve a therapeutic effect, they resort to prescribing a short-term course of treatment with levothyroxine with a further transition to maintenance therapy with iodine preparations.

Monotherapy with iodine preparations is an etiotropic therapy. The works of the last 10-15 years have shown that an increase in the production of TSH or an increase in the sensitivity of thyrocytes to it is only of secondary importance in the pathogenesis of iodine-deficient goiter. With an insufficient supply of iodine to the gland, the amount of iodinated lipids (the main inhibitors of growth factors) decreases, which has a powerful stimulating effect on the growth of thyrocytes.

The main role in this is assigned to local ARFs, such as IRF-1, ERF and FRF.

The stage of the "revival" of therapy with EDZ with iodine began in the 80s of the last century. Many studies were limited by the fact that ultrasound measurements of the size of the thyroid gland could not be performed at that time. So, G. Hintze and D. Emrich in 1983, in their work devoted to the treatment of iodine deficiency goiter, used the size of the neck circumference as the main marker of changes in the volume of the thyroid gland. The authors have shown that the administration of 400 mcg of iodine also effectively reduces the volume of the thyroid gland, as well as 150 mcg of levothyroxine (estimated after 12 months from the start of treatment), and at the same time, in contrast to levothyroxine, the result of iodine therapy persists for a long time after its cancellation. ...

With the increasing adoption of ultrasound in practical medicine, randomized controlled trials are beginning to be conducted on the effect of various regimens of therapy on the course of iodine deficiency goiter. At the same time, the doses of iodine ranged from 100 μg and more, including pharmacological, in the case of using iodized oil. The appointment of 100-150 mcg of iodine has proven itself well in the treatment of goiter in children.

In adults, iodine at a dose of 100-150 mcg per day was not as effective as in children, but a tendency towards a decrease in the volume of the thyroid gland is also observed. In the scientific literature of the 80s of the XX century. you can find works where iodine was used for the treatment of goiter in doses of both 500 mcg, and 400 mcg, and 300 mcg per day. And they all demonstrate comparable efficacy of iodine monotherapy with levothyroxine monotherapy and combination therapy with iodine and levothyroxine preparations, as well as the most persistent effect after drug withdrawal. However, there is evidence that the use of high doses of iodine sometimes causes thyroid dysfunction (hypo- or hyperthyroidism). And although more solid evidence is needed to recognize this fact, at present the following provision is generally accepted: the therapeutic doses of iodine for ECD almost do not differ from the prophylactic ones and are 150-200 μg per day. Thus, when conducting a double-blind, placebo-controlled study in Germany, the efficacy of 200 μg of iodine for the treatment of iodine-deficient goiter was confirmed. The volume of the thyroid gland decreased by 38% in 6 months and remained so for at least the same time. Another study evaluated the effect on gland size of 200 μg iodine and 100 μg levothyroxine. Comparable efficacy of these two dosages was shown, with further emphasis on the fact that the degree of thyroid volume reduction does not depend on the level of TSH.

Numerous contemporary studies have demonstrated success in reducing the prevalence of goiter through the introduction of universal salt iodization programs. As for group prophylaxis, 150 mcg of iodine per day is now quite enough for adolescents, 200 mcg for pregnant and lactating women.

In the scientific literature of recent years, the issue of the development of autoimmune processes in the thyroid gland against the background of taking iodine-containing drugs has been widely discussed. At the same time, there are works both confirming this influence and denying it. G. Kahaly in his works studied the efficacy and safety of low doses of iodine in ECD. He noted that when using 200 μg of iodine per day, an increase in the level of antibodies to thyroid peroxidase, antibodies to thyroglobulin, and a significant increase in lymphocytic infiltration in the gland tissue occur only in 97% of cases. In contrast to these facts, a group of researchers from Austria did not find the above-described changes at all when administering 200 mg of iodine to patients with iodine-deficient goiter. In general, the development of autoimmune processes in the thyroid gland most likely depends on the population characteristics of the region, which requires more detailed, carefully planned studies.

Combined therapy with iodine and levothyroxine preparations can be carried out both by the simultaneous administration of levothyroxine and potassium iodide preparations, and by the use of their fixed combinations. Among them, the most commonly used are preparations containing 100 μg of levothyroxine and 100 μg of iodide (iodothyrox). Iodothyrox therapy has been shown to have a number of benefits.

First, by acting on several pathogenetic mechanisms of goiter formation, both hypertrophy and hyperplasia of thyrocytes are suppressed. This allows you to achieve results that are comparable in effectiveness to monotherapy with levothyroxine (with a much lower content), which, in turn, reduces the amount of side effects associated with taking thyroid medications.

Secondly, the propensity to develop the "withdrawal phenomenon" also decreases with a short break in treatment.

Third, the suppression of TSH levels is less pronounced, for example, compared with the effect of levothyroxine at a dose of 150 μg.

The decrease in goiter volume is more pronounced with combination therapy (40%) than with levothyroxine monotherapy (24%) (Schumm et al.).
Less frequency of side effects of levothyroxine and potassium iodide (since lower dosages are used than with monotherapy).
The effect (reduction of goiter) develops faster than with potassium iodide monotherapy.
Dose titration of levothyroxine is not required, since the ratio active ingredients is selected optimally.

There are many works that support these benefits. One of them compared the treatment of ECD in 74 randomly selected patients. Patients received either 150 μg levothyroxine or 100 μg levothyroxine + 100 μg iodine for 6 months. Against the background of combination therapy, the decrease in the volume of the gland was somewhat more pronounced (by 30% compared to 25%, the difference is not significant). The decrease in the size of the gland did not depend on the degree of TSH suppression. In addition, in the group of patients receiving combined treatment, it was possible to maintain a reduced volume of the gland with replacement therapy with 100 μg of iodine daily. In the group of patients treated with levothyroxine alone, such prophylactic treatment was less effective. The second study included 82 patients who were randomly assigned to therapeutic purpose either 100 μg of levothyroxine or 100 μg of levothyroxine + 100 μg of iodine were prescribed for 6 months. The decrease in the volume of the gland against the background of levothyroxine was 24% compared to 40% against the background of a combination of drugs, the differences were statistically significant. Thus, in adult patients, the combination of levothyroxine plus iodine is a more preferable treatment than iodine monotherapy (at least in the same doses) and is comparable to a similar dose of levothyroxine. Many researchers note that 150 mcg of iodine in combination with an individually adjusted dose of 1 mcg / kg of levothyroxine is more preferable for the treatment of endemic goiter in adults.

Summarizing the above, we can conclude that the main goal in the treatment of iodine-deficient goiter is not only to reduce the volume of the thyroid gland, but also to maintain the achieved result. For this, iodine preparations are suitable both in the form of monotherapy and as part of a combination therapy with levothyroxine.

The question remains, what to appoint in the first place. It is obvious that the intrathyroid iodine concentration significantly increases with the initial intake of iodine preparations, than drugs combined with levothyroxine. This fact once again confirms the etiotropic nature of iodine therapy, as well as the advisability of starting treatment with the appointment of iodine preparations.

In our opinion, the algorithm for ECD therapy can be presented as follows.

For the treatment of children with ECD, potassium iodide is recommended at a dose of 100-150 mcg per day, for adolescents - at a dose of 150-200 mcg per day.
Treatment of adults should be carried out at a young age (up to 45-50 years), since this often leads to the desired result, and there is also a small risk of functional autonomy of the thyroid gland, in which iodine intake can provoke thyrotoxicosis. In the first 6 months, the intake of 200 μg of potassium iodide per day is justified.

Persons with DEZ over 45-50 years old are shown active dynamic observation with an annual determination of the TSH level and an ultrasound of the thyroid gland.

In the absence of a pronounced effect from taking iodine preparations after 6 months, a transition to combination therapy can be recommended. In this case, preference should be given either to a fixed combination of 100 μg of iodine and 100 μg of levothyroxine (iodothyrox), or to an individually selected dose of levothyroxine at the rate of 1 μg / kg of body weight in combination with 150 μg of iodine per day.

But, based on modern concepts, no matter what initial treatment of goiter is carried out, its abrupt cessation cannot be recommended without further preventive measures - the use of iodized salt.

Literature

Gerasimov G. A., Fadeev V. V., Sviridenko N. Yu., Melnichenko G. A., Dedov I. I. Iodine deficiency diseases in Russia. M., 2002.
Gartner R., Dugrillon A., Bechtner G. Evidence that iodolactones are the mediators of growth inhibition by iodine on the thyroid // Acta Med Austriaca. 1996; 23 (1-2): 47-51.
Knudsen N., Bulow I., Laurberg P., Ovesen L., Perrild H. Low socio-economic status and familial occurrence of goitre are associated with a high prevalence of goitre // Eur J Epidemiol. 2003; 18 (2): 175-81.
Kohn L. D., Shimura H., Shimura Y., Hidaka A., Giuliani C., Napolitano G., Ohmori M., Laglia G., Saji M. The thyrotropin receptor // Vitam Horm. 1995; 50: 287-384.
Edmonds C. Treatment of sporadic goitre with thyroxine // Clin. Endocrinol. 1992; 36 (1): 21-23.
Einenkel D., Bauch K. H., Benker G. Treatment of juvenile goitre with levothyroxine, iodide or a combination of both: the value of ultrasound gray-scale analysis // Acta Endocrinol. 1992; 127 (4): 301-306.
Hintze G., Emrich D., Koebberling J. Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicenter trial. // Eur. J. Clin. Invest. 1989; 19 (6): 527-534.
Leisner B., Henrich B., Knorr D., Kantlehner R. Effect of iodide treatment on iodine concentration and volume of endemic non-toxic goitre in childhood // Acta Endocrinol. 1985; 108 (1): 44-50.
Feldkamp J., Seppel T., Becker A., Klisch A., Schlaghecke R., Goretzki P. E., Roher H. D. Iodide or L-thyroxine to prevent recurrent goiter in an iodine-deficient area: prospective sonographic study // World J Surg. 1997; 21 (1): 10-14.
Wilders-Truschnig M. M., Warnkross H., Leb G. The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth stimulating immunoglobulins in endemic goiter patients // Clin Endocrinol (Oxf). 1993; 39 (3): 281-286.
Papanastasiou L., Alevizaki M., Piperingos G., Mantzos E., Tseleni-Balafouta S., Koutras D. A. The effect of iodine administration on the development of thyroid autoimmunity in patients with nontoxic goiter // Thyroid. 2000; 10 (6): 493-7.
Kahaly G. J., Dienes H. P., Beyer J., Hommel G. Iodide induces thyroid autoimmunity in patients with endemic goitre: a randomized, double-blind, placebo-controlled trial // Eur J Endocrinol. 1998; 139 (3): 290-297.
Pfannenstiel P. Therapie der endemischen Struma mit Levothyroxin und Jodid. Ergebnisse einer multizentrischen Studie // Deutsche Med. Wochenschr. 1988; 113 (9): 326-331.
Saller B., Hoermann R., Ritter M., Morell R., Kreisig T., Mann K. Course of thryroid iodine concentration during treatment of endemic goiter with iodine or combination of iodine or levothyroxine // Acta endocrinologica. 1991; 125: 662-667.

E. A. Troshina, Doctor of Medical Sciences
N. V. Galkina
ENTs RAMS, Moscow

Formed in 1959.

Currently, in Russia, housing offices have been replaced by DEZs (directorates of a single customer), which are involved in organizing maintenance of the housing stock.

Notes (edit)

What is HOA, housing and communal services, housing office, housing department, management company?

The Housing and Utilities Administration (HUS) is the local executive organization of the Housing and Utilities Sector (HCS), created in the Soviet Union and continued its work in the Russian Federation. These departments were located in the adjoining territories, within the boundaries of the microdistrict. They had different names depending on the city:

housing maintenance office (ZhEK);
repair and maintenance enterprise (REP);
repair and maintenance department (REU).

All of these institutions were created to maintain multi-apartment housing stock. After the collapse of the Union of Soviet Socialist Republics, when the transfer of housing from state to private ownership began, local bodies of housing and communal services were transferred to the jurisdiction of the municipality and allocated to a separate department.

From the beginning of spring 2005, the new Housing Code began to work. Russian Federation... It spelled out the reform of housing and communal services, with the creation, instead of housing and maintenance departments, management companies (MC) or homeowners associations (HOA). All home management companies are privately owned. Most of them are created on the basis of housing offices and are headed by the same leaders as before.

The entire infrastructure, which used to belong to the housing department, became the property of the UK. This organization, in essence, remains a housing maintenance office that has changed its form of ownership and name. In the old fashioned way, many residents still call the management companies the housing office, although legally this is no longer true.

We will talk further about what services the housing office provides us.

Services

The number of services provided by organizations that are part of the housing and communal services system (housing office, etc.) varies from one to several dozen. Requirements for the timing and order of utility services are constantly being improved and changed.

In our country, there are no free services provided by the housing office. After all, even if the tenants of non-privatized apartments do not pay for any service of the house management company, then the municipality does it for them.

In modern realities, the relationship between the management company and residents is built on a commercial basis. All citizens are obliged to pay utility bills in a timely manner, and the housing department must fulfill the entire service list efficiently and on time.

List of paid utilities:

electricity;
gas supply;
(not only, but also the roofs, porches of the entrance and the block, etc.) and house maintenance (including, the reasons for the appearance, etc.);
other contractual work.

All utilities are paid according to the contract signed between the management company and the owner of the property.

All services and work provided by the ZhEK are divided into two categories: mandatory and optional. We pay for mandatory services on a monthly basis. They are included under the heading "home repair and maintenance" or "home maintenance and repair". As an example - flushing heating system or . Optional is the installation of new heating elements, non-standard plumbing or plastic window blocks. Ordering such services and paying for them is a purely individual matter.

Mandatory services are carried out at different intervals:

when conducting technical rounds and inspections;
when preparing buildings for the autumn-winter period;
according to pollution, need and frequency of use;
in preparation for operation in the spring and summer.

And yes, do not forget that if necessary, you can also get it from the managing organization.

And now we will talk about what the tariffs for housing and communal services depend on.

How to complain about the actions of utilities is described in the following video:

What the rates depend on

What expenses are included in the management fee for an apartment building, we considered in the previous section. And if you take each structure separately, then they are all different and require different maintenance costs. Therefore, the payment for the column "for the maintenance and repair of housing" is different for all residential buildings. It is determined based on defective statements and estimates.

Maintenance and repair costs are calculated based on the estimates required for the maintenance of general engineering systems, for taking readings from metering devices, maintenance, calculation and storage of data and many other items. The cost of maintenance will also depend on what volume and frequency of work will be planned by homeowners.

The procedure for approving the amount of utility bills is determined at a general meeting of homeowners with the obligatory participation of representatives of the house management company. The minimum term for setting a fee is one year.

On termination and conclusion of an agreement with a management company or housing and communal services there will be a speech Further.

The following video tells about how to complain about too high rates:

Maintenance agreement for an apartment building with a management company

The main document that establishes the relationship between the "communal services" and the owners of apartments is a contract for the management of an apartment building. If the owners at the general meeting have chosen a house management company, then the contract is concluded with each of them individually.

When the Criminal Code is chosen by a homeowners' partnership, the contract is signed by the HOA on behalf of all apartment owners. And finally, if the house belongs to the municipality, then the contract is signed on a competitive basis between the housing department and local authorities.

Do I need to make up?

We will immediately answer: it is absolutely necessary. After all, it regulates the amount and cost of utilities and the frequency of their implementation. Items that must be specified in the contract:

a list of services and works for the maintenance and repair of common property;
the composition of the common property;
the procedure for making and the amount of payment for utilities and housing maintenance;
the process of supervising the house management company and the implementation of the Criminal Code of its duties.

And now you will find out what to do if the service agreement apartment building was not concluded with the management company.

What will happen if the contract is not concluded?

So, I did not enter into an agreement with the management company, what of this?

In accordance with the document concluded between the homeowners and the Criminal Code, the owners have the right to demand from the utility organization reporting on the work done and check the quality and frequency of services provided. If violations are found, it is necessary to demand immediate elimination from the management of the housing department. In case of refusal, referring to the contract, you need to complain to the regulatory authorities. For example, to the State Housing Inspectorate and Rospotrebnadzor.

First of all, you must appeal in your complaint by an agreement between you and the house-managed company. And if you do not conclude it, then the "utilities" will find many loopholes to evade their direct duties, which are paid by you monthly.

We really hope that our small essay helped you figure out what you need Management Company what it is and how it differs from the housing office. Do not forget to pay utility bills on time and demand quality work from utility organizations. And be sure to see if you or your HOA have an agreement with the UK. If not, do so immediately. If the "utilities" perform their duties in bad faith, do not hesitate to contact the supervisory organizations or the court. By the way, if you want, then it is worth discussing this issue with the Criminal Code first.

The following video is devoted to the legal aspects of the most frequently asked questions in relation to housing and communal services:

The Zhilfond company, which won the tender for the management of several houses in the Southern Administrative District, faced big problems, which are described by its head Mikhail KONOVALOV.

There is money. It seems to be Several ordinary municipal houses were handed over to us. That is, DEZ was exchanged for a private company, but the rules of the game remained the same. And we understood on our own skin the conditions in which the management of a single customer is. The biggest problem is the budget financing system. This is when money seems to be there, but strictly on a specific article. And there is no way to transfer them to another article. For example, the roof is leaking in a house. Its repair is carried out under the article " overhaul". In order for funds to be allocated under this article, you must submit an application. And wait. And there is money for another article. But the roof cannot be repaired on them - this is a misappropriation of funds. So it was with one of the houses on Vysokaya Street. The roof leaked in March. So we waited with the repairs all the rainy summer, waiting for the money to be allocated to repair the roof. Although there was money in April, it was on a different item, from where it could not be transferred. The roof was repaired only in September. And on the twelfth floor, the plaster was crumbling from dampness, and the staircase had to be repaired. Strangers among strangers And only the organization that passed the competition had to carry out the repairs. Why is there a competition when people are flooded? We would do the repairs ourselves and much cheaper. As a result, much more money was spent. How can moral costs be measured? Residents are nervous, and they do not care about any items of expenditure. Here, instead of their usual DESA, a certain company came. So they are to blame for everything - here they are! So the pilot project showed both the advantages and disadvantages of different forms of public utilities management. The directorate of a single customer operates in the existing system. This is a powerful structure that works according to certain rules, it is easier for it to achieve anything than small businesses that are just entering this industry. They are their own for the authorities. And we are strangers to everyone in any way. Thank God, little by little this is changing. People, ay! There is an opinion that it is better for the management company when residents live on the sly and do not interfere in anything. But I am convinced that this is fundamentally wrong. On the contrary, when a person has an idea of what he needs for comfort, and he declares this, then this is wonderful. If a service is desired, it is in demand differently. For example, if a young subject hears from his parents that they have made repairs in the entrance, it is unlikely that he will cover the freshly painted walls with his “frescoes”. Therefore, it is difficult to overestimate the role of public self-government in the housing sector. If it really exists, and not for show, then it is convenient for us to work with representatives of the local community, with the HOA. A homeowners' association runs private property management companies in a very different way than DEZ. By the way, this was also shown by the pilot project. Here we can determine the sequence of repairs and solve specific improvement cases. And the same roof repairs would have been completed faster and on time. I will give an example of house 7 on Vysokaya Street participating in the pilot project. In order to conduct equal dialogues with the management company, the initiative group and the residents of the house have chosen such a form of organization as a homeowners' association. Employees of the Nagatino-Sadovniki administration helped them in this. They even prepared a special leaflet, which lists the positive aspects of creating an association of homeowners. The HOA was registered recently and has just started work. But the first positive effect already there - concierges at the entrances received lists of telephones by which residents can contact the management company and call the foremen, if necessary. And with the same repairs, residents themselves will decide when to do it, and not wait for the allocation of "targeted" money.

Recorded by Alexey Myasnikov

Each DEZ still has a list of free utilities for residents. In this case, it does not matter what form of ownership of housing. Both in a privatized apartment, in a municipal one, as well as in a service one, the emergency crew is obliged to fix the problems completely free of charge:

List of free services of DEZ

which a person living in the house can count on:

1.change of gaskets
2. stuffing of oil seals water shut-off valves and elimination of water leakage
3.the necessary installation of the insert for the valve seat and polyethylene nozzles to the valve head
4.Elimination of any leak, as well as change of flexible piping used when connecting sanitary devices, overflows and siphons, pipeline sections to plumbing fixtures, replacement of rubber toilet cuffs, marking with cement mortar
5.adjustment of the cistern and elimination of leaks
6. Strengthening a loose toilet bowl, washbasin, sink or sink;
7.Elimination of blockage of internal sewerage pipelines and sanitary devices, which occurred through no fault of residents
8.cleaning and flushing of the entire internal sewerage system
9. adjustment and regulation of hot water supply and heating systems, elimination of air locks, flushing of pipelines and heating systems, replacement of faulty standard heated towel rails, replacement of shut-off and control valves. Such as valves, three-way valves, double-adjusting valves and air valves
10. checking the technical condition of standard gas appliances. If necessary, free replacement of failed parts is done
11. checking the technical condition of standard electric stoves. Broken parts are replaced if necessary
12. general construction works in the volumes necessary to maintain the operational qualities of building structures: minor repairs of floors, window and door fillings, elimination of the consequences of leaks (not through the fault of residents) and other malfunctions;
13.blowing, repair, or complete replacement of current or non-working batteries
14. repair of electrical wiring, including on the staircase.

This must be known and remembered!

Kitchen sinks, bathroom sinks, gas stoves and baths in non-privatized apartments, the housing office is obliged to replace after 15-30 years of use completely FREE OF CHARGE !!!.

LIST OF GENERAL FREE SERVICES:

1.walls and facades:
- sealing of emerging seams and cracks, re-laying of damaged sections of brick walls, repair of plaster, insulation of walls with freezing areas.
- replacement of drains of window openings
- strengthening of canopies, various fences and porch railings

2.roofs, gutters:
- replacement (full or partial downpipes
- repair or replacement of roof sections
- repair of waterproofing and insulation layer of the attic

3.windows, doors:
- replacement of damaged glass windows and doors in public places
- strengthening and regulation of the spring travel on the entrance doors
- installation of handles and latches on windows and doors
- insulation of windows and doors

4.gender:
- replacement of floor areas and floor coverings in places that belong to the property of the house
- waterproofing of the floor in individual bathrooms of apartments with a change of coverage after the expiration of the standard period of use

5. improvement of the yard:
- harvesting grass and leaves. cleaning of bulky waste

6. sanitary cleaning of housing:
- wet sweeping of staircases and flights of the first 2 floors - daily
- wet sweeping of landings and flights above the second floor - weekly

Wet cleaning of areas in front of garbage chute valves - weekly
- washing the elevator car - daily
- cleaning of staircases and flights of stairs - monthly
- washing windows, damp wiping of walls, doors and shades on staircases, as well as window sills and heating appliances, mailboxes and attic stairs, cabinets for electricity meters and low-current devices, and window bars, - annually in the spring

MAINTENANCE OF GENERAL COMMUNICATIONS

1.central heating:
- shutdown of radiators at their slightest leak
- flushing of heating and hot water supply systems in a way of choice: hydraulic or hydropneumatic
- elimination of air congestion in batteries and risers of the house
- insulation of pipelines in the attic and in the basement

2.water supply, sewerage and hot water supply:
- elimination of leaks, change of any gaskets and stuffing of glands in water taps and valve taps in technical undergrounds and premises of elevator units
- sealing of squeegees
- adjustment and repair of cisterns
- cleaning of pipelines of mountains. and cold. water supply

3.power supply:
- replacement of out-of-order light bulbs
- strengthening of lampshades and fragile sections of external wiring

HOUSE EMERGENCY SERVICE:

1.water supply, sewerage and hot water supply:
- change of leaky water taps and mixers, showers and sinks, sinks and washbasins, toilets and bathtubs, as well as any valves in apartments due to the expiration of their useful life
- replacement of unusable units of water heating columns and chimney pipes that are out of order due to physical wear

- change of pipeline sections up to 2 meters
- elimination of sewage blockages inside the building
- welding work on the repair or complete replacement of the pipeline

2. central heating:
- repair or complete replacement of damaged valves
- elimination of leaks by sealing pipe connections, fittings or heating devices
- repair or complete replacement of squeegees on the pipeline
- change of pipeline sections up to 2 meters and sections of heating devices
- welding works for the repair or replacement of pipeline sections
- installation of air valves
- work on troubleshooting stoves and hearths, the users of which are more than 1 apartment, re-laying them in special cases

3) power supply:
- replacement of failed sections of the building's electrical network, excluding residential networks (only common areas in communal apartments)
- repair of electrical panels, switching on and replacing damaged electrical protection machines and packet switches
- replacement of fuse-links on electrical panels
- replacement of light sources
- replacement of leaky burners and switches, oven heaters and other elements of standard electric stoves in residential apartments

4. other types of work in the elimination of accidents:
- an excerpt of trenches
- pumping out water in the basement
- opening floors and punching furrows over hidden pipelines
- disconnection of risers in sections of the pipeline, emptying of the included sections of the center system. heating and hot water supply, as well as refilling them and starting the system after the accident is eliminated.

Homeowners' association, housing office, housing department, housing and communal services, management company: what is it and how do they work? Diffuse euthyroid goiter: diagnosis and treatment Emergency home care

DEZ treatment

Literature

Notes (edit)

Links

see also

See what "DES" is in other dictionaries:

Books

What is HOA, housing and communal services, housing office, housing department, management company?

Services

What the rates depend on

Maintenance agreement for an apartment building with a management company

Do I need to make up?

What will happen if the contract is not concluded?

List of free services of DEZ

LIST OF GENERAL FREE SERVICES:

MAINTENANCE OF GENERAL COMMUNICATIONS

HOUSE EMERGENCY SERVICE:

Recommended to read

Homeowners' association, housing office, housing department, housing and communal services, management company: what is it and how do they work? Diffuse euthyroid goiter: diagnosis and treatment Emergency home care

DEZ treatment

Literature

Notes (edit)

Links

see also

See what "DES" is in other dictionaries:

Books

What is HOA, housing and communal services, housing office, housing department, management company?

Services

What the rates depend on

Maintenance agreement for an apartment building with a management company

Do I need to make up?

What will happen if the contract is not concluded?

List of free services of DEZ

LIST OF GENERAL FREE SERVICES:

MAINTENANCE OF GENERAL COMMUNICATIONS

HOUSE EMERGENCY SERVICE:

Recommended to read

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